Relationships between income, subjective health and caregiver burden in caregivers of people with dementia in group living care: a cross-sectional community-based study

Association between chronic illnesses in older adults and caregiver burden: a cross sectional study in the United States

OBJECTIVES

Caregiver burden is a growing social issue with an increase in the number of older adults with chronic illnesses. We analyzed the association between chronic illnesses among older adults and caregiver burden in financial, emotional, and physical domains, adjusting for caregiver and older adult characteristics.

METHOD

We used secondary data from the 2022 National Health and Aging Trends Study and the 2022 National Study of Caregiving. Logistic regression analyses was used to assess associations between nine illnesses and each caregiver burden in 1,419 participants.

RESULTS

Dementia was significantly associated with caregiver burden related to emotional difficulty (odds ratio [OR] = 2.04; 95% confidence interval [CI], 1.34-3.09) and physical difficulty (OR = 1.67, 95% CI, 1.01-2.78), but not financial difficulty. Furthermore, relationship with older adults, positive and negative self-esteem, the number of assistive activities of caregivers, and gender and physical capacity of older adults were significantly associated with caregiver burden.

CONCLUSION

These findings clarify the definition of caregiver burden and provide integrated results on caregiver burden in chronic illnesses and the characteristics of caregivers and older adults.

But at What Cost? Healthcare Utilization of Canadian Carer-Employees

Caregiving plays a crucial role in aging societies by supporting individuals with chronic illnesses, disabilities, or aging-related needs. The unpaid labour provided by caregivers diverts healthcare resources from the formal healthcare system; however, this incurs costs to the caregivers themselves in terms of declines in personal wellbeing. This study explores the relationship between caregiving and healthcare spending for two groups of caregivers: eldercare only and sandwiched. We found that physician visits were the most common resource used by caregivers, at a mean of 3.69 (SD = 4.01) visits over a 6-month period, excluding non-users of this service. This was followed by mental health services (M = 5.86, SD = 7.02), emergency room visits (M = 1.77, SD = 1.38), and hospital admissions (M = 3.61, SD = 8.53). There were no significant differences in healthcare utilization between eldercare and sandwiched caregivers. There were mixed results regarding characteristics associated with greater resource use; however, the hours of weekly caregiving were most consistently associated with greater healthcare utilization, indicating that healthcare use may increase with care burden.

Exploring confidence in financial planning topics among care partners of persons living with dementia

OBJECTIVE

Care partners of persons living with dementia perform significant financial planning in partnership with the person for whom they care. However, research is scarce on care partners' confidence and experiences with financial planning. The purpose of this study was, first, to quantify care partners' confidence across different financial planning topics. We sought to understand whether income, education, relationship type, and years of experience are related to care partners' level of confidence in financial planning. Second, we sought to better understand the reasons for these confidence ratings by examining care partners' experiences of financial planning.

METHODS

We conducted an online survey that asked a combination of quantitative and qualitative questions to understand care partners' confidence and experiences with financial planning. Participants were nationally recruited care partners of persons living with dementia. Multivariate linear regression was used to understand different subgroups' levels of confidence in each financial planning topic. Inductive thematic analysis was used to understand qualitative data.

RESULTS

The financial planning topics in which participants (N = 318) felt the least confident were: options when there is not enough money to provide care; tax deductions available to cut care costs; and sources of money from government programs for which the care recipient is eligible. Differences in confidence were observed among care partners with lower incomes, less experience, and caring for a parent. Qualitatively, participants described the challenges of care budgeting and protecting personal finances; confusion about long-term care insurance and accessing resources; and, among confident care partners, reasons for this sense of preparedness.

CONCLUSIONS

These results underscore the need for tailored interventions and technologies that increase care partners' confidence in specific aspects of financial planning, including long-term care insurance, available financial support, and what to do when money runs out.

Quality of life of caregivers of patients on home enteral nutrition

BACKGROUND

Home enteral nutrition (HEN) patients often rely heavily on caregivers (CGs), whose quality of life (QoL) is significantly impacted. This study aimed to identify potentially modifiable factors influencing the QoL of CGs of HEN patients.

METHODS

A multicentre, cross-sectional study was conducted in three home nutrition centers from Jan 2021 to Jan 2022. We enrolled 90 CGs of HEN patients, collecting data on QoL (WHOQOL-BREF), depression (Beck Depression Inventory), CG burden (Zarit Burden Interview), sleep quality (Pittsburgh Sleep Quality Index), stress (Perceived Stress Scale), life satisfaction (Satisfaction With Life Scale) and financial status.

RESULTS

The mean age of CGs was 54.53 years, with 76% being female. 19% of CGs rated their QoL as poor, and 57% had depression. Multivariate regression analysis showed that financial satisfaction (β = 0.14, p < 0.01) and depression (β = -0.03, p < 0.001) were significant predictors of QoL (R2 = 0.6). Depression correlated with CG burden (r = 0.54, p < 0.001), poor sleep quality (r = 0.47, p < 0.001), stress (r = 0.68, p < 0.001), and financial satisfaction (r = -0.39, p = 0.001). The average monthly income per person was $663.3 and 51.2% of CGs were not satisfied with their financial situation. Lower income was correlated with stress (r = -0.298, p = 0.023). CG burden was associated with financial satisfaction (r = -0.373, p < 0.001), quality of sleep (r = 0.296, p = 0.005) depression (r = 0.54, p < 0.001), stress (r = 0.5, p < 0.001) and satisfaction with life (r = -0.389, p < 0.001).

CONCLUSIONS

CGs of HEN patients face substantial challenges impacting their QoL, particularly financial stress and depression. Addressing these issues through comprehensive support systems is crucial to improve CG well-being and, subsequently, patient care outcomes.

Using Exploratory Structural Equation Modeling to Examine Caregiver Distress and Its Contributors

OBJECTIVES

To develop and test the direct and indirect associations between caregiver distress and its many contributing factors and covariates.

DESIGN

Analysis using data from a national, cross-sectional survey of Canadian caregivers.

SETTING AND PARTICIPANTS

A total of 6502 respondents of the 2012 General Social Survey-Caregiving and Care-receiving who self-identified as a caregiver.

METHODS

We used exploratory structural equation modeling to achieve our aims. Based on literature review, we hypothesized a structural model of 5 caregiving factors that contribute to distress: caregiving burden, caregiving network and support, disruptions of family and social life, positive emotional experiences, and caregiving history. Survey items hypothesized to measure each latent factor were modeled using exploratory factor analysis (EFA). After establishing a well-fit EFA model, structural equation modeling was performed to examine the relationships between caregiving factors and caregiver distress while controlling for covariates such as caregiver's and care-recipient's sociodemographic characteristics and kinship.

RESULTS

EFA established a well-fit model that represented caregiver distress and its 5 contributing factors as hypothesized. Although all 5 had significant effects on caregiver distress, disruptions of family and social life contributed the most (β = 0.462), almost 3 times that of caregiving burden (β = 0.162). Positive emotional experiences also substantially reduced distress (β = -0.310).

CONCLUSIONS AND IMPLICATIONS

Understanding the multifaceted nature of caregiver distress is crucial for developing effective strategies to support caregivers. In addition to reducing caregiving burden, having flexible resources and policies to minimize disruptions to caregivers' families (eg, flexible work policies; family-oriented education, training, and counseling) and enhance the positive aspects of caregiving may more effectively reduce distress.

Mental states in caregivers toward people with Alzheimer's disease at different stages

Introduction

Caring for people with Alzheimer's disease (AD) is burdensome, especially when family members act as caregivers. This multicenter survey first aimed to investigate caregivers' mental states as well as its influencing factors in caring for people with different severities of AD in China.

Methods

People with AD and their caregivers from 30 provincial regions in mainland China were enrolled from October 2020 to December 2020 to be surveyed for caregivers' mental states and living conditions, as well as caregivers' attitudes toward treatment and caring. Logistic regression was used to explore the factors that influence the positive and negative states of caregivers who care for people with different stages of AD.

Results

A total of 1,966 valid questionnaires were analyzed (mild AD: 795, moderate AD: 521, severe AD: 650). A total of 73.6% of caregivers maintained normal states (mild group: 71.9%, moderate group: 73.9%, severe group: 75.2%; X2 = 2.023, p = 0.364), and the proportions of caregivers with positive and negative states were 26.3% (mild group: 38.4%, moderate group: 24.6%, severe group: 13.1%; X2 = 119.000, p < 0.001) and 36.5% (mild group: 25.2%, moderate group: 36.9%, severe group: 50.2%; X2 = 96.417, p < 0.001), respectively. The major factors that both influenced caregivers' positive and negative states were the severity of AD, perceived efficacy of treatment, safety issues after AD dementia diagnosis and perceived social support (p < 0.005), while neuropsychiatric symptoms causing stress in caregivers (p < 0.001) only affected the negative states of caregivers. The results of further analysis according to disease severity showed that safety issues after AD dementia diagnosis (p < 0.005) only made significant differences in the mild-to-moderate group.

Conclusion

To reduce negative states and promote positive states among caregivers, flexible and sensitive caregiving support could be built on caregivers' demands in caring for people with different stages of AD. The support of emotion, social functioning and nursing skills is one of the significant ways for health workers to enhance caregivers' competency.

"I Lay Awake at Night": Latino Family Caregivers' Experiences Covering Out-of-Pocket Costs When Caring for Someone Living With Dementia

BACKGROUND AND OBJECTIVES

The financial burden of caregiving has received less research attention than physical and emotional costs. This is especially true for underserved ethnic minorities. Financial strain affects mental and physical health and is unequally distributed across caregivers of different races and ethnicities. Although caregivers overall spend, on average, one quarter of their income on caregiving, Latino caregivers, the focus of this study, spend nearly half.

RESEARCH DESIGN AND METHODS

To better understand this disparity, we conducted 11 qualitative interviews with 14 Latino caregivers of persons living with dementia located in either California or Texas. Interview transcripts were thematically coded, guided by a material-psychosocial-behavioral conceptual model of financial strain.

RESULTS

We identified 3 themes: daily needs and costs, psychological distress caused by financial issues, and stressful barriers to accessing family and societal support. Furthermore, interviews revealed how Latino culture may influence spending patterns and management of costs. Findings suggest that preference by Latino families to care for a family member in the home may be met with a financial disadvantage due to the high out-of-pocket costs of care.

DISCUSSION AND IMPLICATIONS

A better understanding of the factors contributing to high costs for Latino caregivers and how these costs affect caregivers will inform approaches at both the individual and policy levels and develop culturally relevant interventions to help Latino families to lower caregiving costs. This is especially important as the number of Latinos living with dementia is expected to increase over the next 4 decades and effective interventions are lacking.

Service Design of a Loss Prevention Device for Older Adults with Dementia

This aim of this research was to explore the appraisal of the use of smart alert bracelets by older adults diagnosed with dementia. Convenience sampling was adopted to recruit older adults with dementia in Yunlin County, Taiwan. A manual questionnaire survey was conducted, and SPSS 26.0 statistical software was used for analysis. The results of this study showed noticeable positive correlation results in the post-test for the modes "wearing device", "degree of dementia", and "field configuration". Based on the experimental results, the following suggestions are provided: (1) in terms of statistical calculation, the statistical results were affected by changes in some participants; (2) as for the design of equipment, to be more suitable for adult use, the size and color of bracelets need to be optimized; (3) as for the problem of battery charging of the device, because the charging location of the device is not easy to find, it is better to extend device standby time; (4) regarding the selection of equipment, older adults with early-stage dementia could be concerned about the function of the wearable device, so it is recommended to provide a device designed with clear functions, such as a watch, so that older adults are more willing to wear it. Patients diagnosed with moderate and severe dementia should be advised to use concealed non-sensory devices, such as charms and cards, to better facilitate assistance from caregivers in wearing them; and (5) as for the device, in case of a loss event, in addition to mobile phone notifications, other light and sound device notifications can be added, allowing caregivers to pay more attention to information in real time. In summary, the feedback from caregivers and older adults suggests that if the device is to be used without charging, the overall design should be light and small, which is more suitable for service designs.

Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia

Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.

Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study

PURPOSE

Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet.

METHODS

This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet.

RESULTS

Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving.

CONCLUSION

The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.

Assessment of the Burden of Care and Burnout Level in Caregivers of Dementia Patients in a Home Care Setting

Aim: This study aims to evaluate the factors affecting the care burden and burnout levels of caregivers with dementia patients receiving home care services. Methods: This descriptive study was conducted in Samsun Training and Research Hospital Home Care Services which paid a visit at home between March 20 and June 20, 2021. The caregivers of the patients who were followed up by the diagnosis of dementia were included in the study after having agreed to participate in the study with their written informed consents. The 'Socio-demographic Data Form', 'Zarit Burden Interview' and 'Maslach Burnout Inventory’ were administered to caregivers during face-to-face interviews. Results: A total of 157 caregivers were included in our study, of which 70.1% (n=110) were women. 68.2% (n=107) were in the 40-64 years age group. The mean Zarit Burden Interview score was calculated as 47.10±16.14 (min=21, max=85). 76.4% of caregivers had moderate to severe escalated care burden. Once the impact of the increase in caregiver burden score on Maslach Burnout Inventory subgroups was examined, the relationship was found to be positively significant with emotional exhaustion and depersonalization, and negatively significant with personal achievement. Conclusion: As the burden of care increases, the level of burnout of individuals increases. Female gender, illiteracy, lack of income, duration of care given which is prolonged for more than one year, and daily care duration exceeding 12 hours were determined as outstanding factors that increase the care burden and level of burnout. Keywords: home care services, caregivers, dementia, caregiver burnout

Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study

Caring for a relative with a severe mental disorder puts family caregivers to a great risk of depression. While overall caregiving burden is a strong predictor of depression, the contribution of the various dimensions of burden to caregivers' depression as well as their relationships with depressive symptoms has received little attention. 384 family caregivers completed a cross-sectional online survey including the Center for Epidemiological Studies Depression (CES-D) scale, the Zarit Burden Interview (ZBI), and the Brief Experience of Caregiving Inventory (BECI), measuring caregiving burden and experience. We estimated the structure of the relationships between caregiving experiences (i.e., ZBI and BECI subscales) and CES-D symptoms using a network approach. Negative Emotion/Consequences, (lack of) Positive Personal Experience, and Stigma/Effects on Family were the most connected caregiving dimensions to depression. To untangle the role of the Negative Emotion/Consequences component (by far the most central node in estimated networks), a secondary analysis incorporating its composing items was estimated. Losing control over life, feeling strained around the relative and impaired self-perceived health emerged as central nodes. Interestingly, these caregiving-related dimensions or experiences were differentially connected to depressive symptoms. We discuss how these findings might help future research and inform tailored psychoeducational interventions for family caregivers of people with a severe mental disorder.

Themes describing social isolation in family caregivers of people living with dementia: A scoping review

INTRODUCTION

The number of people with dementia has been increasing. Evidence shows that over 16 million family caregivers provide unpaid care for people with dementia. However, family caregivers experience several challenges throughout their caregiving role, including that of social isolation. Although social isolation in people with dementia has been well documented, social isolation in their family caregivers has not received as much scholarly attention. This scoping review sought to address this dearth of research through the following research question: "What are themes, concepts, or constructs that describe social isolation of family caregivers for people living with dementia?".

METHOD

An electronic search was conducted in PubMed, PsycInfo, and Scopus, using the following Boolean search phrase: dementia AND "social isolation" AND (caregiver OR carers). Content analysis was conducted to identify relevant themes.

FINDINGS

The initial search yielded 301 studies. Through screening processes, 13 studies were eligible for review. Based on a synthesis of evidence, five themes emerged from the data: disease progression, psychological state, social networks, social supports, and technology.

DISCUSSION

This review demonstrates that caregiving is related to social isolation in family caregivers of people living with dementia. The experience of social isolation was related to the progression of dementia, psychological states, and lack of supports. In contrast, social supports, social networks, and using technology may reduce social isolation. Identifying themes provides policy and practice implications, such as using information and communication technology to create and redefine social networks.

Longitudinal analysis of local government spending on adult social care and carers' subjective well-being in England

OBJECTIVES

Reform of England's social care system is repeatedly discussed in the context of increasing demand, rising costs and austere policies that have decreased service provision. This study investigates the association between unpaid carers' subjective well-being and local government spending on adult social care (ASC).

SETTING AND PARTICIPANTS

Our sample consists of 110 188 observations on 29 174 adults in England from the 2004-2007 British Household Panel Survey and the 2009-2018 UK Household Longitudinal Study. The data on local authorities' spending on ASC where participants live is derived from the publications Personal Social Care Expenditure and Unit Costs (2004-2016); and ASC Activity and Finance Report England (2016-2018).

OUTCOME MEASURES

Subjective well-being is measured by the 12-item version of the General Health Questionnaire (GHQ-12) and 12-item version of the Mental Component Summary (MCS-12). We applied fixed-effects linear models to investigate the moderating effect of ASC spending on the association between subjective well-being and caring, controlling for a range of socioeconomic and demographic variables.

RESULTS

Carers have a lower level of subjective well-being compared with non-carers, evident in their higher average GHQ-12 Likert score (β=2.7277 95% CI 0.2547 to 5.2008). Differences in the subjective well-being of carers and non-carers decrease with local government spending on ASC. Subjective well-being for carers was at a similar level to that of non-carers in high ASC spending local authorities (GHQ-12: -0.0123 95% CI -0.2185 to 0.1938, MCS-12: 0.0347 95% CI -0.3403 to 0.4098) and lower in other areas (GHQ-12: 0.1893 95% CI 0.0680 to 0.3107, MCS-12: -0.2906 95% CI -0.5107 to -0.0705). The moderating effect of ASC spending is found among people who care for 35+ hours per week.

CONCLUSION

Government spending on ASC protects unpaid carers' well-being, and people providing more than 35 weekly hours of unpaid care are more likely to benefit from the current social care system.

Factors influencing caregiver burden by dementia severity based on an online database from Seoul dementia management project in Korea

Backgrounds

As the prevalence of dementia rises, caregiver burden also increases in South Korea, especially for informal family caregivers. This study aimed to analyze factors affecting caregiver burden by the severity of dementia based on data of patients in Seoul.

Methods

A total of 12,292 individuals aged ≥65 years enrolled in the Seoul Dementia Management Project from 2010 to 2016 in an online database were selected. Caregiver’s burden was assessed using the Korea version of Zarit Burden Interview. Multiple regression analyses were performed to determine factors associated with primary caregiver’s burden after stratifying the severity of dementia.

Results

Most patients showed moderate levels of cognitive impairment (49.4%), behavior problems (82.6%), and ADL dependency (73.6%). After stratifying the severity of dementia, caregivers caring for patients with mild symptoms of dementia were experienced with higher caregiver burden if patients were under a lower score of IADL. Significant factors for caregiver burden among caregivers supporting patients with moderate symptoms of dementia include caregivers’ residence with patients, subjective health status, and co-work with secondary caregivers. Lastly, caregivers for patients with severe dementia symptoms experienced a higher caregiver burden from limited cognitive function, problematic behavior, and caregivers’ negative health status.

Conclusion

In terms of sample size, this study had far more patients than any other domestic or international study. It was meaningful in that it analyzed characteristics of patients with dementia and caregivers affecting the burden of caregivers in Korea. Intensive social supports with multiple coping strategies focusing on different levels of patients’ clinical symptoms and caregivers’ needs should be planned to relieve the caregiver burden.

Predictors of Caregiver Burden of Patients with Alzheimer Disease Attending Day-Care Centres

Nowadays, there are plenty of programs and resources to prevent caregiver burden of patients with Alzheimer’s disease. In spite of that, many caregivers suffer high levels of burden and stress, which leads to an earlier institutionalization of patients. This study aimed to explore the predictors of burden in relative caregivers of patients attending day-care centers and the moderating role of caregiver kinship in these associations. A sample of a hundred and two patient–caregiver dyads was recruited. Burden was measured with a Zarit Burden Interview. Measures of patients’ cognition, insight, depression, behavioral disturbances, functional ability and overall physical health were considered as predictors. We found that apathy, irritability and delusions and, patients’ mobility are the main determinants of caregivers’ burden. The strength of relationship between delusions and irritability was higher in spouse caregivers. Interventions to reduce burden should be adapted to the specific needs of a particular type caregiver.

Frailty Does Not Impact Caregiver Burden in Patients with Cirrhosis

BACKGROUND

Frailty is common and is associated with increased mortality, lower quality of life, and higher readmission rates in cirrhotic patients. Not only are these outcomes important, but further understanding the impact of frailty on a caregiver's life is crucial to better comprehend caregiver burden in cirrhotic patients and develop strategies to improve care for patients and their caregivers.

METHODS

A single-center, prospective study was conducted of cirrhotic patients and their caregivers between 4/1/2019 and 11/1/2019. Frailty testing combined aspects from the Fried Frailty Instrument, Short Physical Performance Battery, and activities of daily living. Caregivers completed questionnaires to evaluate caregiver burden using the Zarit Burden Interview (ZBI-12), and perceived social support, using the Interpersonal Support Evaluation List.

RESULTS

In total, 94 cirrhotic patients were included, 50% males with a median age of 63.1 years. The most common etiology of cirrhosis was nonalcoholic steatohepatitis. Frailty was prevalent (45.1%). In total, 12.8% of caregivers reported a high burden based on ZBI-12. There was no association between frailty and caregiver burden, hospitalization rates, or death. However, frailty was associated with a higher number of outpatient GI visits (p = 0.002). Lower perceived social support among caregivers was associated with a higher caregiver burden (p < 0.0001).

CONCLUSION

Frailty is prevalent in cirrhotic patients but is not associated with higher rates of caregiver burden. Low perceived social support among caregivers, however, was associated with higher caregiver burden. It is important to recognize the impact of caregiver burden on caregivers of cirrhotic patients and ensure caregivers have the appropriate support to mitigate burden.

Prevalence and Predictors of Caregiver Burden in a Memory Clinic Population

BACKGROUND

Although caregiver burden is common among carers of people with dementia, little is known about its prevalence and predictors among caregivers of patients attending memory clinics.

OBJECTIVE

To examine carer and patient-specific characteristics associated with caregiver burden across the cognitive spectrum in a memory clinic population.

METHODS

Consecutive patients referred to a university hospital geriatric memory clinic were included. Caregiver burden was scored using the Caregiver Burden Score (CBS), (modified Zarit), with scores≥15/30 suggesting burden. BPSD were measured with the dysfunctional behaviour rating instrument (DBRI). Cognition was screened using the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen.

RESULTS

In all, 351 patients were included, median age 77 (±11) years; 65.5% were female. The prevalence of caregiver burden was 33.6% overall, increasing from 10.8% in subjective cognitive decline (SCD), to 15% in mild cognitive impairment (MCI) and 43% in dementia; CBS scores were significantly higher in dementia (p < 0.001). Caregivers with burden were significantly younger (p = 0.045) and were more likely to be adult children (p = 0.007). The CBS weakly correlated with the stage of cognitive impairment (r = 0.16) but had moderate correlation with MoCA (r = -0.54) and Qmci scores (r = -0.60). After adjustment for co-variates, DBRI scores alone independently predicted burden (odds ratio 1.23;1.11-1.35, p < 0.001).

CONCLUSION

Caregiver burden is associated with the stage of cognitive impairment, with higher prevalence proportions in those with dementia compared with MCI and SCD. Only the severity of neuropsychiatric symptoms independently predicted caregiver burden in this population and its presence should prompt assessment for burden.

Factors Associated with Burden in Caregivers of Patients with End-Stage Kidney Disease (A Systematic Review)

BACKGROUND

Caring for a patient with end-stage kidney disease (ESKD) is highly stressful and can impact negatively on the physical and psychological well-being of caregivers. To accurately assess caregiver burden (CB), health care providers (HCPs) need to identify characteristics associated with an increase in CB.

AIM

The aim of this review is to explore CB in caregivers of adult patients with ESKD and to identify characteristics associated with any increase in CB.

METHOD

A comprehensive literature search was completed using five electronic databases. Medline, Embase, CINHAL, PsycINFO, and Scopus. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. No time limit for the date of publication of studies was employed, to enable the inclusion of more extensive literature.

RESULTS

A total of 38 relevant studies from 18 countries were identified and included in the review. A variety of patient and caregiver factors can impact positively or negatively on CB, including socio-demographic factors of patients and caregivers, disease-related factors, situational and relational factors, environmental factors, and psychological factors.

CONCLUSION

This review provides awareness to HCPs of the important factors associated with CB, when assessing or targeting interventions for caregivers experiencing burden.

The Trajectory of Caregiver Burden and Risk Factors in Dementia Progression: A Systematic Review

Background:

Caring for patients with dementia at home is often a long-term process, in which the independence of the patient declines, and more responsibility and supervision time is required from the informal caregiver.

Objective:

In order to minimize and reduce caregiver burden, it is important to explore its trajectory and the accompanying risk factors as dementia progresses; the objective of this systematic review.

Methods:

PRISMA guidelines were followed in this systematic review. Three databases, PubMed, PsycINFO, and EMbase, were systematically searched in November 2019 using specific keywords.

Results:

1,506 hits emerged during the systematic search but only eleven articles actually met the inclusion criteria for this review. The trajectory of caregiver burden is highly variable and depends on multiple factors. Important risk factors included: patients’ behavioral and neuropsychiatric symptoms, and their decline in functioning in (I)ADL; the caregiver’s age, gender, and physical and mental health; and, within the dyads (patient/caregiver), cohabitation and kinship.

Conclusion:

There is no one-size-fits-all for predicting how caregiver burden will change over time, but specific factors (like being a spouse and increased behavioral impairment and decline in functional status in the patient) may heighten the risk. Other factors, not yet comprehensively included in the published studies, might also prove to be important risk factors. Future research in the field of reducing caregiver burden is recommended to integrate the patient, caregiver, and context characteristics in the trajectory of caregiver burden, and to assess more clearly the phase of the dementia progression and use of external resources.

The Arabic and Hebrew versions of the caregiving ambivalence scale (CAS): examining its reliability, validity, and correlates among Israeli caregivers of individuals with Alzheimer's disease

Objectives: Providing care for family members with Alzheimer's disease (AD) might awaken ambivalent feelings in caregivers. This topic, however, has received little research attention. Having reliable and valid scales is a first step in expanding our knowledge in this area, particularly among different cultural groups, as ambivalent emotions have been found to be dependent on culture. Thus, the aims of this study were (1) to test the reliability and validity of the Caregiving Ambivalence Scale (CAS) among Israeli Jewish and Arab caregivers of individuals with AD and (2) to examine the contribution of caregivers' ethnocultural affiliation (Jewish/Arab) to the experience of ambivalent feelings.Methods: Structured face-to-face interviews were conducted with 370 family caregivers (adult children and spouses) of elderly people with AD. Approximately half of the participants (55.3%) were Israeli Jews (79.5% female; 61.3% adult children; mean age = 65.52), and the rest (44.7%) were Israeli Arabs (87.4% female; 72% adult children; mean age = 54.28).Results: Our findings indicated that the CAS has good-to-excellent internal reliability and validity both in Hebrew and Arabic. Additionally, as expected, ethnocultural affiliation (Jewish/Arab) made a unique - although modest - contribution to the explanation of ambivalence as reflected in the CAS score, with Arab caregivers reporting significantly higher levels of ambivalent feelings than did Jewish caregivers.Conclusions: The CAS is a reliable and valid structured measure to assess ambivalent feelings among Arab and Jewish caregivers of individuals with AD in Israel. Cultural context is a unique factor in understanding their mixed emotions.

Effects of traditional Chinese exercise on patients with cognitive impairment: A systematic review and Bayesian network meta-analysis

Objective

To systematically review the effectiveness of four types of traditional Chinese exercise (TCE) on patients with cognitive impairment (CI) and to rank these four TCE types.

Design

A Bayesian network meta‐analysis.

Methods

Four English databases, including PubMed, EMBASE, Cochrane Library and Web of Science, and three Chinese databases, including CNKI, VIP and Wanfang, were searched from their inception to December 2019. Randomized control trials conducted to verify the effects of TCE on patients with CI were included. We used network meta‐analysis to evaluate the relative effects and rank probabilities of the four types of TCE.

Results

The results of the network meta‐analysis indicated that baduanjin (N = 9), tai chi (N = 11), liuzijue (N = 2) and qigong (N = 1) all had significant benefits compared with control conditions. According to the ranking probabilities, baduanjin was most likely to be associated with substantial improvement in cognition, followed by tai chi, liuzijue and qigong.

Conclusion

Our study revealed the effectiveness of TCE for improving global cognition in adults with cognitive impairment. Baduanjin may be the most effective exercise type. The evidence summarized in our study still contains bias, and more research should be carried out to verify the validity of TCE.

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.

Predictors of caregiver burden in aged caregivers of demented older patients

BACKGROUND

Dementia in the oldest-old is projected to increase exponentially as is the burden of their caregivers who may experience unique challenges and suffering. Thus, we aim to investigate which factors are associated with older caregivers' burden in caring demented outpatients in a multicenter cohort.

METHODS

Patients and their caregivers, both aged ≧65 years, in the National Dementia Registry Study in Taiwan (T-NDRS) were included in this study. Caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). The correlations between the ZBI scores and characteristics of caregivers and patients, including severity of dementia, physical comorbidities, instrumental activities of daily living (IADL), neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI), and family monthly income, were analyzed.

RESULTS

We recruited 328 aged informal caregiver-patient dyads. The mean age of caregivers was 73.7 ± 7.0 years, with female predominance (66.8%), and the mean age of patients was 78.8 ± 6.9 years, with male predominance (61.0%). Multivariable linear regression showed that IADLs (β = 0.83, p < 0.001) and NPI subscores of apathy (β = 3.83, p < 0.001)and irritability (β = 4.25, p < 0.001) were positively associated with ZBI scores. The highest family monthly income (β = - 10.92, p = 0.001) and caregiver age (β = - 0.41, p = 0.001) were negatively correlated with ZBI scores.

CONCLUSIONS

Older caregivers of older demented patients experience a higher care burden when patients had greater impaired functional autonomy and the presence of NPI symptoms of apathy and irritability. Our findings provide the direction to identify risky older caregivers, and we should pay more attention to and provide support for these exhausted caregivers.

Self-reported symptoms of depression and anxiety among informal caregivers of persons with dementia: a cross-sectional comparative study between Sweden and Italy

Background

Around 50 million people worldwide are diagnosed with dementia and this number is due to triple by 2050. The majority of persons with dementia receive care and support from their family, friends or neighbours, who are generally known as informal caregivers. These might experience symptoms of depression and anxiety as a consequence of caregiving activities. Due to the different welfare system across European countries, this study aimed to investigate factors associated with self-reported depression and anxiety among informal dementia caregivers both in Sweden and Italy, to ultimately improve their health and well-being.

Methods

This comparative cross-sectional study used baseline data from the Italian UP-TECH (n = 317) and the Swedish TECH@HOME (n = 89) studies. Main outcome variables were the severity of self-reported anxiety and depression symptoms, as measured by the Hospital Anxiety and Depression Scale (HADS). HADS scores were investigated using descriptive and bivariate statistics to compare means and standard deviations. Linear regressions were used to test for associations between potential factors and self-reported symptoms of depression and anxiety.

Results

Italian informal caregivers reported more severe symptoms of depression and anxiety than Swedish caregivers. In Italy, a higher number of hours of caregiving was associated with anxiety symptoms (β = − 1.205; p = 0.029), being 40–54 years-old with depression symptoms (β = − 1.739; p = 0.003), and being female with symptoms of both depression (β = − 1.793; p < 0.001) and anxiety (β = 1.474; p = 0.005). In Sweden, a higher number of hours of caregiving and being < 39 years-old were associated with depression symptoms (β = 0.286; p < 0.000; β = 3.945; p = 0.014) and a higher number of hours of caregiving, the lack of additional informal caregivers and dementia severity were associated with anxiety symptoms (β = 0.164; p = 0.010; β = − 1.133; p = 0.033; β = − 1.181; p = 0.031).

Conclusion

Multiple factors are associated with self-reported symptoms of depression and anxiety among informal caregivers in Sweden and Italy. Factors found in this study partly differ between the two countries, suggesting the important role of cultural and social factors affecting the experience of caregiving. A deeper knowledge of these factors may increase the knowledge on potential protective and risk factors, provide information to policymakers and ultimately improve the psychological well-being of informal caregivers to people with dementia across Europe.

Evaluation of a Caregiver-Friendly Workplace Program Intervention on the Health of Full-Time Caregiver Employees: A Time Series Analysis of Intervention Effects

OBJECTIVE

To evaluate effectiveness of a workplace educational intervention at improving health-related outcomes in carer-employees.

METHODS

A pre-post test design compared with health of a sample (n = 21) of carer-employees before (T1) and after (T2) a workplace intervention, as well as a final timepoint (T3) 12 months after T1. An aggregate health score was used to measure health and consisted three scales; depression (CES-D), psychosocial (CRA), and self-reported health (SF-12), where higher scores indicated higher frequency of adverse health symptoms. Three random-slope models were created via the linear mixed modeling method (LMM) to illustrate changes in reported health.

RESULTS

All three LMM models reported a reduction in participants' health score, particularly between T1 and T2, indicating a decrease in reported adverse health symptoms.

CONCLUSION

The intervention was successful in improving the health of carer-employees.

Predictors of caregiver distress among spouses, adult children living with the person with dementia, and adult children not living with the person with dementia

AIM

The caregiving situation differs according to the type of relationship between the patient caregiver, and among dementia caregivers, living with the person with dementia can contribute to caregiver distress. This study aimed to identify the predictors of caregiver distress based on caregiver profile: spouse, adult child living with the person with dementia, and adult child not living with the person with dementia.

METHOD

In total, 213 caregivers participated in this study. Their responses to questionnaires helped identify the positive and negative implications of the caregiving situation and the level of caregiver distress. The analyses consisted of univariate and multiple linear regression models using a forward method.

RESULTS

Based on the standardized beta scores, the variables that are the most significant in predicting spouse caregiver distress are the impact on health and impact on schedule. The variable that is the most significant in predicting the distress of adult child caregivers living with the person with dementia is the impact on health. The variables that are the most significant in predicting the distress of adult child caregivers not living with the person with dementia are the impact on health, impact on schedule, and impact on finances.

CONCLUSION

The results make it possible to consider different approaches to providing support, including evaluating the health of all caregivers, giving guidance on accepting help and focusing caregivers' actions on their values for spouse caregivers, providing family mediation for adult child caregivers living with the person with dementia, and offering information and assistance on the available aids for adult child caregivers not living with the person with dementia.

Exploring the Relationship between the Caregiver's Stress Load and Dementia Patient Behavior: A Case Study of Dementia Specialist Outpatient Data from the Southern Medical Center of Taiwan

The aim of this study was to explore the relationship between caregivers' stress loads and dementia patient behavior, including the correlation of "patient behavior" (severity and frequency), "social care system", and "stress levels of caregivers". The research method was based on the analysis of survey data collected at a dementia specialist outpatient clinic of a medical center in southern Taiwan from November 2013 to May 2015. Those surveyed by the center included patients who visited the hospital, and their caregivers completed a questionnaire survey. During the study period, a total of 558 questionnaires for 279 pairs were distributed, and all questionnaires were recovered. According to the survey statistics, the average age of the caregivers interviewed was 53.1 years; women accounted for 61.3% of respondents, and the duration of care exceeded three years. In terms of education, most respondents were college/university graduates. The most common surveyed relationship was that of children acting as the caregiver to a parent, and the average age of the patients was 77.73 years. Most caregivers were found to live with the patients (75.3%). In terms of severity and frequency, the surveyed items with the highest average scores were both the "delusion" item of the "patient behavior" facet, the "mental support"(mean = 1.97; standard deviation, SD = 0.869) item of the "social care system" facet, and the "social life stress" (mean = 2.26, SD = 1.510) item of the "Stress levels of caregivers" facet. The research results show that the "patient behavior" and "Stress levels of caregivers" facets have a significant positive correlation, and the "social care system" and "Stress levels of caregivers" facets have a significant negative correlation. In the future, priority of service planning and implementation of long-term policy should be given to home care, since this is a cultural characteristic of Taiwan. In circumstances where a primary caregiver takes care of family members, the patient's behavior, length of care, mental support, and social life issues are key items that should be considered in the social welfare control service to alleviate the load of dementia patients on family caregivers.

Can drawings help assessing dementia caregivers' burden? A preliminary study

The use of quantitative self-report methods for assessing the stress associated with dementia caregiving, especially among minority groups, has been lately criticized. The aim of this study was to examine whether Human Figures Drawings might provide a tool for assessing caregivers' burden. Sixty Israeli Arabs – 30 family caregivers of a person with dementia and 30 gender and age-matched non-caregivers – were asked to draw a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability. While no differences were found between the drawings of caregivers and non-caregivers, statistically significant differences were found between all the characteristics of the drawings depicting a caregiver of an elderly person with dementia and a caregiver of an elderly person with a physical disability, as drawn by caregivers. Several of the drawings' characteristics were significantly associated with caregiver burden. By introducing a nonverbal form of expression, Human Figures Drawings might add utility to the assessment of dementia caregivers' burden.

State of household need for caregivers and determinants of psychological burden among caregivers of older people in Thailand: An analysis from national surveys on older persons

OBJECTIVES

To explore the levels and trends of household need for caregivers of older people and to explore the impact of potential determinants of psychological burden among caregivers of older people in Thailand.

METHODS

The secondary data analysis was performed using the Survey of Older Persons in Thailand 2007, 2011, and 2014 datasets which conducted by the National Statistical Office of Thailand. The household need for caregivers of older persons refers to having at least one older person in the household who needs a caregiver for assistance with activities of daily living. Caregiver mental health, which is confined to the available 2011 data, is defined as a state of psychological burden. Ordinal logistic regression models were used to explore the impact of potential determinants of psychological caregiver burden.

RESULTS

The household need for caregivers in Thailand tends to be increasing, from 5.0% in 2007 to 6.6% in 2014. The levels of the household need for caregivers were significantly higher in urban areas, Bangkok, and high socioeconomic households. In terms of psychological caregiver burden, the Thai Mental Health Indicators in 2011 produced, on average, a fair level of mental health, but one-fourth of caregivers had poor mental health. Duration of care for older people, household wealth, and functional dependency significantly predict total caregiver burden. Household characteristics are vital in predicting psychological caregiver burden, and the adjusted effect of the fifth quintile of household wealth was high (odds ratio = 2.34; 95% confidence interval = 1.47-3.73).

CONCLUSION

The increasing need for caregiving in households with an older person can lead to a higher caregiver burden, particularly among those caregivers who care for dependent older people in poor households. Longer duration of caregiving is a factor that mitigates this burden.

Financial Strain, Employment, and Role Captivity and Overload Over Time Among Dementia Family Caregivers

BACKGROUND AND OBJECTIVES

This study examined how financial strain and changes in employment status affect subjective stressors over 12 months in 184 family caregivers of individuals with dementia.

RESEARCH DESIGN AND METHODS

Subjective stressors of role overload and role captivity, and employment status were measured at baseline, 6-, and 12-months. Self-reports on financial strain were measured at baseline only. Caregivers were categorized into 3 groups based on changes in their employment status during the study over 12 months: (a) who were never employed, (b) who experienced some sort of employment status change, either going from employment to unemployment or vice versa, and (c) who were always employed. Growth curve analyses were conducted to examine within-person changes in role overload and role captivity, and associations with employment and financial strain.

RESULTS

Caregivers with greater financial strain at baseline had higher levels of role overload and increasing role captivity over time. Caregivers who experienced a caregiving transition and had low financial strain at baseline showed greater decrease in role captivity over 12 months. Although caregivers who were consistently unemployed reported lower levels of role overload, they also showed steeper increase over time than those who were consistently employed.

DISCUSSION AND IMPLICATIONS

Caregivers' perceptions of financial strain add to the long-term stress of the caregiving role. Changes in caregivers' employment status may have complex associations with their feelings of stress over time.

Burden among caregivers of people with mental illness at Jimma University Medical Center, Southwest Ethiopia: a cross-sectional study

BACKGROUND

Burden of caregivers of people with mental illness (PWMI) is considered to be a negative impact of the care provided by the family to the patient. However, little is known about the extent of the burden among caregivers of PWMI in Ethiopia. The aim of this study, therefore, is to assess the magnitude and associated factors of burden among caregivers of PWMI at Jimma University Medical Center, 2017.

METHODS

Institution-based cross-sectional study design was employed among 406 conveniently selected caregivers of PWMI and interviewed using a structured questionnaire. Family burden interview schedule (FBIS) was used to assess burden of caregivers. Bivariate and multivariable linear regression analyses were performed to determine the predictors of burden among caregivers.

RESULTS

Nearly two-thirds [264 (65.0%)] of the participants were male with a mean age of 38.45 ± 12.03 years. The mean score for burden among caregivers on family burden interview schedule was 23.00 ± 10.71. Age of the caregivers (β = 0.18, p < 0.001), being female caregiver (β = 2.68, p < 0.01), duration of contact hours with the patient per day (β = 0.74, p < 0.001), perceived stigma by the caregiver (β = 0.47, p < 0.001), and providing care for patients who had history of substance use in life (β = 1.52, p < 0.05) were positive predictors of higher burden among caregivers. Whereas, caregivers' income (β = 7.25, p < 0.001), caregivers who had no formal education (β = 4.65, p < 0.01), and caregivers' social support (β = 0.78, p < 0.001) were negatively associated with higher burden among caregiver.

CONCLUSION

Caregivers of people with mental illness experience enormous burden during providing care for their relatives with mental illness. Therefore, creating community awareness and targeted interventions in the area of treatment access, stigma, financial, and other social support for people with mental illness and their caregivers would help out to reduce these burdens.

The effect of patient care education on burden of care and the quality of life of caregivers of stroke patients

Background

Care for stroke patients at home is a very complicated and tough activity.

Objective

The study was conducted to examine the effect of patient care education on burden of care and quality of life of caregivers of stroke patients.

Materials and methods

The study was an educational trial conducted on 100 caregivers of the stroke patients in Al-Zahra educational hospital, Isfahan, Iran. The intervention group received some training to empower caregivers in family-oriented care in form of an educational counseling program. Data were collected and analyzed using the questionnaires, including demographic, quality of life Short Form-36, and Zarit burden of care questionnaires.

Results

The mean ages of caregivers were 48.52 years in the intervention and 45.14 years in the control groups. The results indicated significant differences in mean of quality of life and burden of care in the caregivers of the intervention group after intervention (P<0.01), which was insignificant in the control group. The average burden on the caregivers of both groups was significantly associated with health status, economic status, marital status, the number of children, care hours, care days, and familial relationship of the caregivers with the patients (P<0.01) before intervention. In addition, quality of life of both groups was significantly related to their health status (P<0.01) before intervention.

Conclusion

Patient care education reduced the burden of care and improved quality of life of the caregivers of stroke patients. Thus, to reduce the complications of caring for stroke patients, family education should be the priority of nursing and discharging procedures.

Depression Among Caregivers of Patients With Dementia

We aimed to assess depressive symptoms in caregivers of patients with dementia, taking into account variables such as severity of dementia, sex, age, and financial state of the patient. We recruited 222 caregivers of patients with dementia from King Abdulaziz Medical City, Saudi Alzheimer’s Disease Association, and online, from February to June 2017, and employed the Patient Health Questionnaire to assess depression, and the Blessed Dementia Scale to assess severity of dementia. The prevalence of clinical depression among the caregivers was 14.9%. Minimal symptoms of depression were experienced by 96 caregivers (43.2%), moderate by 45 (20.3%), moderate-severe by 15 (6.8%), and severe by 8 (3.6%). Forty-six patients had mild dementia (22%), 73 had moderate (34.9%), and 90 had severe (43.1%). Caregivers of patients with dementia experience considerable burden and lower level of health-related quality of life and may be predisposed to developing clinical depression.

Recovery from burden: informal caregiver profiles that predict treatment success

ABSTRACTBackground:Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference?

METHODS

This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3).

RESULTS

Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC.

CONCLUSION

Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.

Developing a random forest classifier for predicting the depression and managing the health of caregivers supporting patients with Alzheimer's Disease

BACKGROUND

Supporting the caregivers of dementia patients is an important issue in the field of public health.

OBJECTIVE

This study established a model for predicting the depression of dementia caregivers while considering the sociodemographic and health science characteristics of South Koreans. The results of this study provided baseline data for developing and applying a caregiver management App.

METHODS

This study analyzed 2,592 adults (⩾ 19 years old; 1154 men and 1438 women) who were caregivers (e.g., family and caregivers) of demented elderly (⩾ 60 years old).

RESULTS

The results of developed random forest model showed that gender, subjective health status, disease or accidence experience within the past two weeks, the frequency of meeting a relative, economic activity, and monthly mean household income were the major predictors for the depression of caregivers. The prediction accuracy of the model was better than K-NN and support vector machine.

CONCLUSIONS

It was proved that the developed random forest-based App for predicting and managing the depression of dementia caregivers used an algorithm that has a high predictive power. It is required to develop a customized home care system that can prevent and manage the depression of the caregiver.

Common mental disorder among family carers of demented older people in Brazil

Objective:

Population aging is a global phenomenon associated with a rising prevalence of chronic degenerative diseases such as dementia. Dementia poses a challenge not only for patients but also their family caregivers who, in exercising this role, are at higher risk of mental illness. The present study investigated the prevalence of common mental disorders (CMD) in family caregivers of demented elderly seen at a geriatric outpatient clinic of a Brazilian teaching hospital.

Methods:

A cross-sectional study was conducted in which the following assessment instruments were applied: the Self Reporting Questionnaire, Zarit Burden Interview, Hospital Anxiety and Depression Scale and Mini-Mental State Examination (caregivers aged ≥65 years) plus a sociodemographic questionnaire.

Results:

The sample comprised 90 caregivers; 83 (92.2%) women, 51 (56.7%) married, 60 (66.7%) son/daughter of elder and 62 (68.6%) holding another job besides caring for the demented elder. Caregivers had a mean age of 57.3 (±11.7) years and mean education of 9.5 (±4.9) years; 62.2% of caregivers were diagnosed with common mental disorder, 50% exhibited anxiety symptoms, 52.2% depression symptoms and 66.7% reported burden. Caregivers with common mental disorder had higher scores on the anxiety, depression and burden scales (p<0.01). Logistic regression showed that caregivers with anxiety symptoms were 15 times more likely to present common mental disorder (OR: 15.0; 95% CI: 3.5-71.2) and caregivers with symptoms of depression were 8 times more likely to have CMD (OR: 8.0; 95% CI: 2.1-31.1).

Conclusion:

Results revealed a high prevalence of common mental disorder in the population studied.

Development and validation of a screener based on interRAI assessments to measure informal caregiver wellbeing in the community

Background

Informal caregivers are invaluable partners of the health care system. However, their caring responsibilities often affect their psychological wellbeing and ability to continue in their role. It is of paramount importance to easily identify caregivers that would benefit from immediate assistance.

Methods

In this nonexperimental cohort study, a cross-sectional analysis was conducted among 362 informal caregivers (mean age 64.1 years, SD ± 13.1) caring for persons with high care needs (mean age 78.6 years, SD ± 15.0). Caregivers were interviewed using an interRAI-based self-reported survey with 82 items covering characteristics of caregivers including key aspects of wellbeing. A factor analysis identified items in the caregiver survey dealing with subjective wellbeing that were compared against other wellbeing measures. A screener, called Caregiver Wellbeing Index (CWBI), consisting of four items with response scores ranging from 0 to 2 was created. The CWBI was validated in a follow-up study in which 1020 screeners were completed by informal caregivers of home care clients. Clinical assessments of the care recipients (n = 262) and information on long-term care home (LTCH) admission (n = 176) were linked to the screener dataset. The association between the CWBI scores and caregiver and care recipient characteristics were assessed using logistic regression models and chi-square tests. The reliability of CWBI was also measured.

Results

The CWBI scores ranging from zero to eight were split in four ‘wellbeing’ levels (excellent, good, fair, poor). In the validation study, fair/poor psychological wellbeing was strongly associated with caregiver reports of inability to continue in their role; conflict with family; or feelings of distress, anger, or depression (P < 0.0001). Caregivers caring for a care recipient that presented changes in behavior, cognition, and mood were more likely to present fair/poor wellbeing (P < 0.0001). Additionally, caregivers with high CWBI scores (poor wellbeing) were also more likely to provide care for someone who was admitted to a LTCH (OR 3.52, CI 1.32–9.34) after controlling for care recipient and caregiver characteristics. The Cronbach alpha value 0.89 indicated high reliability.

Conclusion

The CWBI is a valid screener that can easily identify caregivers that might benefit from further assessment and interventions.

[Care of parents with dementia: comparison of caregiving sons and daughters]

BACKGROUND

In view of the demographic changes and the associated increasing need for care, the role of caregiving sons will also become more important; however, little is known about the caregiving experiences of sons.

OBJECTIVE

Potential differences between caregiving sons and daughters were investigated with respect to the style of caregiving, the feeling of stress and burden and the utilization of support offers.

MATERIAL AND METHODS

Baseline survey data from the interventional study Tele.TAnDem conducted from September 2012 to January 2014 were analyzed. From the total sample of 322 caregiving relatives of people suffering from dementia the participating sons (n = 17) were selected. For comparison 17 participants from the subsample of daughters (n = 111) were selected by propensity score matching. The analyses were conducted using t‑tests, Mann-Whitney tests and χ²-tests.

RESULTS

The analyses regarding the style of caregiving, the feeling of stress and burden and the utilization of professional and informal assistance did not reach statistical significance. Daughters scored on average higher than sons only with respect to the acceptance of the caregiving situation (p < 0.05).

CONCLUSION

Overall caregiving daughters and sons did not differ with respect to caregiving experiences as strongly as previously assumed. Perhaps earlier studies found more gender differences because caregiving sons compared to daughters already have different initial situations, which however remained uncontrolled.

Socioeconomic and demographic factors modify observed relationship between caregiving intensity and three dimensions of quality of life in informal adult children caregivers

Background

The relationship between informal caregiving intensity and caregiver health is well-established, though research suggests this may vary by caregiver demographics. The aim of this exploratory study is to assess the association between caregiving intensity and three dimensions of quality of life outcomes, and determine how caregiver sociodemographics change the nature of this relationship among informal adult children caregivers.

Methods

Using the 2011 National Study of Caregiving, associations between caregiving intensity and quality of life were examined in caregivers providing care to an aging parent (n = 1014). Logistic regression was used to model caregiver quality of life on caregiving intensity using an ordinal composite measure of caregiving activities, including Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), hours per month, and length of caregiving, stratified by race/ethnicity, gender, age, and family income. Odds ratios and corresponding 95% confidence intervals were calculated.

Results

Associations between caregiving intensity and quality of life varied substantially by race/ethnicity, gender, age, and annual family income. White caregivers were significantly more likely to experience negative emotional burden when providing high intensity care (ADL: 1.92, Hours: 3.23). Black caregivers were more likely to experience positive emotions of caregiving (ADL: 2.68, Hours: 2.60) as well as younger caregivers (Hours: 8.49). Older caregivers were more likely to experience social burden when providing high ADL, IADL, and monthly hours of care.

Conclusions

These findings demonstrate the complex and multi-dimensional nature of caregiving, and emphasize the need to develop approaches that are tailored to the specific health needs of subpopulations of informal caregivers.

Mental health and reactions to caregiving among next of kin of older people (65+) with multi-morbidity discharged home after hospitalization

BACKGROUND

Older people with multi-morbidity are major users of healthcare and are often discharged from hospital with ongoing care needs. This care is frequently provided by informal caregivers and the time immediately after discharge is challenging for caregivers with new and/or additional tasks, resulting in anxiety and stress.

AIM

This study aimed to describe mental health, with particular reference to anxiety and depression and reactions to caregiving, and to investigate any associations between the two, in next of kin of older people with multi-morbidity after hospitalisation. It also aimed to explore the association between the demographic characteristics of the study group and mental health and reactions to caregiving.

METHODS

This was a cross-sectional questionnaire study using the Hospital Anxiety and Depression Scale and the Caregiver Reaction Assessment. The study group consisted of 345 next of kin of older people (65+) with multi-morbidity discharged home from 13 medical wards in Sweden. Data were analysed using descriptive and analytical statistics. To identify whether reactions to caregiving and next of kin characteristics were associated with anxiety and depression, a univariate logistic regression analysis was performed.

RESULTS

More than one quarter of respondents showed severe anxiety and nearly one in 10 had severe depressive symptoms. The frequencies of anxiety and depression increased significantly with increased negative reactions to caregiving and decreased significantly with positive reactions to caregiving. Regarding caregiving reactions, the scores were highest for the positive domain Caregiver esteem, followed by the negative domain Impact on health. Women scored significantly higher than men on Impact on health and spouses scored highest for Impact on schedule and Caregiver esteem.

CONCLUSIONS

Nurses and other healthcare professionals may need to provide additional support to informal caregivers before and after discharging older people with significant care needs from hospital. This might include person-centred information, education and training.

Access to Community Living Infrastructure and Its Impact on the Establishment of Community-Based Day Care Centres for Seniors in Rural China

Community-based day care centres play an important role in service delivery for Chinese seniors. Little research has examined how community living infrastructure has influenced the establishment of these day care centres in rural communities. The purposes of this study were: (1) explore regional differences in community living infrastructure; and (2) to examine the impact of such infrastructure on the establishment of day care centres for Chinese seniors in rural communities. The data were derived from “The Fourth Sample Survey on the Living Conditions of Elderly People in Urban and Rural China (2015)”. The establishment of at least one day care centre was the outcome of interest, which was dichotomized at the community level into the establishment of at least one day care centre or the absence of any day care centres. Logistic regression analysis was employed to examine the impact of various community living infrastructural characteristics on the establishment of day care centres. The results showed that of the 4522 rural communities surveyed in 2015, only 10.1% had established at least one day care centre. Community living infrastructural characteristics that were significantly associated with the establishment of day care centres were the availability of cement/asphalt roads, natural gas, tap drinking water, sewage systems, and centralized garbage disposal. Our findings suggest that the significant association between community-level characteristics, especially community living infrastructure, and the establishment of rural day care centre for seniors may inform policy decision making.

Kinship and cohabitation in relation to caregiver burden in the context of Alzheimer's disease: a 24-month longitudinal study

OBJECTIVES

The aims of the study were to identify the clinical characteristics of three groups of caregivers: spouses, live-in adult-child or non-live-in adult-child, and their relation to the degree of perceived burden (Caregiver Burden Interview).

METHODS

The sample comprised 275 Alzheimer's disease primary caregivers, with a follow-up of 24 months. Cognitive, functional and behavioural characteristics were evaluated in persons with dementia, whilst sociodemographic data, use of socio-medical resources, physical and mental health and self-perceived burden were assessed in caregivers. Generalized estimating equations were used for longitudinal data analysis.

RESULTS

Spouse caregivers were 45.0% men, sole caregivers (>80%), used few external resources and had worse physical health. The number of female adult-child caregivers was higher (>75%). The live-in adult-child group, compared with the non-live-in adult-child group, was less likely to be married, had a lower level of education, was more commonly the sole caregiver and used fewer external resources. The greatest burden was observed in live-in adult-child caregivers, and the lowest in the non-live-in adult-child group, with no significant variation in the follow-up for both groups. Spouses had an intermediate level of perceived burden, which rose significantly during follow-up (p < 0.001).

CONCLUSIONS

Kinship and cohabitation with the persons with dementia were associated with different scores and evolution of the burden, with an increase in the follow-up of the spouses, and with more or less burden, depending on cohabitation, in the adult-child groups. Interventions to reduce the level of burden on caregivers should consider these differences. Copyright © 2017 John Wiley & Sons, Ltd.

Factors associated with health-related quality of life among family caregivers of disabled older adults: a cross-sectional study from Beijing

Because of the aging population and the shortage of standardized institutional solutions for long-term care (LTC) in China, family caregivers in Beijing are increasingly called upon to provide home care for disabled older adults. Caregivers face a heavy care burden, and decreased physical and mental health (MH). This study aims to describe health-related quality of life (HRQoL) and to identify its predictors for Chinese family caregivers of disabled older adults.A total of 766 caregivers were recruited from 5 communities in the Dongcheng District of Beijing. Measures included the 36-item Short-Form Health Survey (SF-36), the Zarit Caregiver Burden Interview (ZBI) scales, and the Chinese Social Support Rating Scale (SSRS). Hierarchical multiple regression (HMR) analysis was used to identify the predictors.HMR analysis showed that each block of independent variables (demographic characteristics of disabled older adults, demographic characteristics of caregivers, caregiving context, and subjective caregiver burden) had contributed significantly to caregivers' physical and mental quality of life. Subjective caregiver burden explained the greatest amount of total variance in all MH subscales and the 2nd greatest amount of variance in most physical subscales. Therefore, subjective caregiver burden was the strongest predictor of HRQoL.Our findings suggest that a decrease in caregiver burden can improve caregivers' HRQoL, and additional social support is important in decreasing the impact of caregiving on HRQoL. Importantly, an LTC system should be established in China as soon as possible.

Effects of Spiritual Group Therapy on Caregiver Strain in Home Caregivers of the Elderly with Alzheimer's Disease

INTRODUCTION

Care of patients with Alzheimer's disease is one of the most difficult types of care that exposes the caregiver to a high level of care strain. The present research aimed at determining the effect of spiritual care on caregiver strain of the elderly with Alzheimer's disease.

METHODS

An experimental study was carried out on 100 caregivers who were selected by convenience sampling and randomly divided into intervention, control one and control two groups. Group spiritual therapy was performed on the intervention group for five weeks, Control one participate in the group sessions without any particular interventions, and control two received no interventions. Data was collected through a demographic questionnaire and Robinson's (1983) Caregiver Strain Index, and analyzed using the Chi-square, Fisher's Exact test, one-way analysis of variance and paired t-test. Statistical significance level was considered as 0.05.

RESULTS

In the intervention group mean of the posttest care strain score 32.43±2.73 was significantly lower than pretest 37.16±1.26 (P<0.001). The mean posttest score of care strain was significantly lower in the intervention group compared to the two other groups (P<0.001).

CONCLUSION

Spiritual care can reduce care strain in home caregivers of the elderly with Alzheimer's disease.

Do determinants of burden and emotional distress in dementia caregivers change over time?

OBJECTIVES

Caring for a patient with dementia is a real challenge and can have considerable psychological consequences in the long run. Many caregivers, mostly relatives, feel highly burdened. To develop effective caregiver support to prevent caregivers from getting overburdened, insight is needed into the determinants of burden. The objective of this study is to explore which patient and caregiver characteristics determine the different kinds of caregiver burden over time, both in the short and in the long run.

METHOD

The study was longitudinal. Data on patients and caregivers, general burden and emotional distress were collected at three times: at baseline, at the end of treatment and at nine months. The study was conducted in a psychiatric skilled nursing home with a unit for integrative reactivation and rehabilitation (IRR) and at different sites of home-/day care, assisted living arrangements and nursing home wards (usual care).

RESULTS

General burden is shown to be determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, health-related quality of life. Emotional distress is determined by severity of patient's neuropsychiatric symptoms, caregiver's sense of competence, high affiliation and patient gender.

CONCLUSION

In preventing or treating caregiver burden, professional interventions need to aim specifically at diminishing the neuropsychiatric symptoms in dementia patients and improving the sense of competence in caregivers.