Spouse and Adult-Child Dementia Caregivers in Chinese American Families: Who Are More Stressed Out?

Changes and predictors of resilience among wife and husband caregivers of patients with advanced cancer: A longitudinal study

BACKGROUND

Resilience as a dynamic process plays a significant role in caregivers' mental health. Little is known about gender differences in the resilience process and predictors of resilience in spousal caregivers.

AIM

To investigate changes in resilience among wives and husbands of patients with advanced cancer over a 6-month posttreatment period, and identify different predictors of resilience between females and males.

DESIGN

This longitudinal, observational study was conducted from January to December 2022.

SETTING/PARTICIPANTS

Spousal caregivers of patients with newly diagnosed advanced cancer were recruited from five regional tertiary hospitals in China. There were three assessment points at 1, 3, and 6 months post-initial treatment. The dependent variable was resilience, and five independent repeated variables were investigated.

RESULTS

Totally, 179 wife caregivers and 133 husband caregivers were included. Resilience in both wife caregivers and husband caregivers increased over time (Wald χ2 = 29.83, p < 0.001) but husbands had higher levels of resilience than wives (Wald χ2 = 35.59, p < 0.001). However, there was no interaction between time and gender (Wald χ2 = 5.25, p > 0.05). Patient functional status, caregiver burden, social support, coping self-efficacy, and mutuality were predictors of resilience for wife caregivers. Meanwhile, patient functional status, caregiver burden and coping self-efficacy could predict resilience for husband caregivers.

CONCLUSIONS

Healthcare providers may develop gender-specific interventions to promote resilience in spousal caregivers of patients with advanced cancer. This would improve mental health for caregivers in the process of palliative care.

Determinants of Caregiver Burden Among Primary Family Caregivers of Bedridden Older Adults Living at Home

BACKGROUND

Bedridden older adults require comprehensive care as they cannot perform daily activities independently and rely on their caregivers for their well-being. Limited studies have investigated perceived caregiving burden in this population, or the factors associated with this burden.

PROPOSE

This study aimed to examine the caregiving duration and perceived caregiver burden level of family caregivers of bedridden older adults and to identify factors influencing caregiver burden.

METHODS

This cross-sectional study recruited 120 participant dyads from a Central Thai province. Dyads included 1 bedridden older adult and their family caregiver. Bedridden older adults answered interviewer-administered questionnaires, and family caregivers completed self-reported questionnaires. These included demographic questions, caregiving information, the Zarit Burden Interview, the Multidimensional Scale of Perceived Social Support, and the Perceived Stress Scale. Data were analyzed using bivariate and multivariate tests.

RESULTS

The average caregiving time was 6.84 h/day, and caregivers reported mild-to-moderate burden levels. The multiple regression model explained 34.8% of the variance in caregiver burden. Higher caregiver burden was significantly associated with greater levels of perceived stress (β = 0.49, P < .001), being a spouse of the care recipient (β = -0.20, P < .01), and lower levels of perceived social support (β = -0.16, P = .04).

CONCLUSION

This study highlights the need for nurses to develop and test culturally tailored interventions that are effective in supporting family caregivers in caregiving responsibilities. Results suggest that strengthening caregivers' social support, offering support for spouse and married caregivers, and reducing caregiver stress are areas for interventions.

Caregiver burden of Alzheimer's disease among informal caregivers: a cross-sectional study in Malaysia

Alzheimer's disease (AD) not only impacts the patients but substantially informal caregivers in terms of physical and psychological burden. This study aims to determine the burden level of informal caregivers of patients with different stages of AD and use of special accommodation (SpA) along with its predictors. A cross-sectional study was conducted by interviewing AD patients and informal caregivers recruited from 4 tertiary hospitals. Zarit Burden Interview (ZBI) was used to estimate caregivers' burden. The analysis categorized informal caregivers of AD patients into two groups based on the use of SpA. Multivariable linear regression was employed to identify potential determinants of subjective caregiver burden. As a result, caregivers' burden experienced by informal caregivers of severe community-dwelling AD patients was significantly higher (p = 0.024) than those with special accommodation. As AD advanced, caregivers' burden was elevated significantly (p = 0.021) from mild to severe AD among community-dwelling patients. In multivariable analysis, severe AD (standardised β = 0.187, p = 0.047 vs. mild AD) and spousal relationship (standardised β = 0.241, p = 0.026 vs. other relationships) were found to be significant factors in predicting caregivers' burden. Hence, the physical and social needs of informal caregivers must not be overlooked. Severe AD significantly increased caregiver burden in community dwelling patients. Spousal caregivers report a higher perceived burden compared to caregivers with other relationships. Policymakers need to recognize and address the substantial demands placed on informal caregivers by providing essential social support. Special accommodation could alleviate the burden on informal caregivers, particularly those caring for patients with severe AD.

Association Between Depressive Symptoms in Spousal Caregivers and Falls in Care Recipients With Disability: A Nationwide Population-Based Cohort Study

OBJECTIVE

To investigate the association between depressive symptoms in spousal caregivers and both fall risk and the frequency of falls requiring medical treatment in care recipients with disabilities.

DESIGN

A retrospective cohort study.

SETTING

Data from the China Health and Retirement Longitudinal Study.

PARTICIPANTS

1357 patient-caregiver dyads.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The incidence of falls and the frequency of falls requiring medical treatment among care recipients.

RESULTS

The mean (standard deviation) age of care recipients was 61.6 (9.1) years, and 62.1% of them were women. After adjusting for covariates, it was found that caregiver depressive symptoms were associated with a 32% higher risk of falls (relative risk [RR], 1.32; 95% confidence interval [CI], 1.08-1.61). Moreover, caregivers who exhibited depressive symptoms only at follow-up had a RR of falls requiring medical treatment of 2.74 (95% CI, 1.28-5.88), whereas those who had depressive symptoms at both the baseline and follow-up had a RR of 2.13 (95% CI, 1.19-3.80). The likelihood ratio test showed that grouping depressive symptoms significantly improved the model fit for both fall risk (likelihood ratio [LR] χ²(3)=8.89, P=.031) and falls requiring medical treatment (LR χ²(3)=14.50, P=.002).

CONCLUSION

Caregiver depressive symptoms are significantly associated with an increased risk of falls and a higher frequency of falls requiring medical treatment among care recipients with disabilities. Addressing the mental health of caregivers may help reduce fall-related risks in this population.

Association Between a Family Caregiver's Relationship to Persons With Dementia and Cardiovascular Disease by Race and Ethnicity: A Secondary Analysis of the Behavioral Risk Factor Surveillance System Data

BACKGROUND

Caregiver stress is linked to key mechanisms for developing cardiovascular disease and the burden differs by caregiving relationship (eg, spouse). Furthermore, cardiovascular disease risk in family caregivers (FCGs) has been shown to differ by race and ethnicity. However, little is known about whether the association between caregiving relationship and FCGs' cardiovascular health differs by race and ethnicity.

OBJECTIVE

This study examined the association between an FCG's relationship to persons with dementia and risk factors for cardiovascular disease and cardiovascular disease conditions and identified how these associations differed by race and ethnicity in FCGs.

METHODS

This was a secondary analysis of the 2015-2020 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System data. Logistic regression models were used to examine the associations between predictors (caregiving relationship, race/ethnicity, and their interaction) and outcomes (cardiovascular disease risk and conditions).

RESULTS

A sample of 6042 FCGs of persons with dementia were included. When analyzing race/ethnicity groups as a whole, cardiovascular disease risk and conditions differed significantly by caregiving relationship. Notably, spouse caregivers were at higher risk of diabetes, stroke, angina, and myocardial infarction, while showing lower rates of current smoking, heavy drinking, and obesity, compared to adult children. The associations between caregiving relationship and select cardiovascular disease risk factors (depression, previous smoking) differed significantly between racial and ethnic groups.

CONCLUSIONS

There is a need to develop culturally appropriate cardiovascular preventive health care strategies that reduce cardiovascular disease risks by considering caregiving relationship. Research is especially needed among minoritized racial and ethnic FCG groups.

Exploring Family Caregiver Burden Using the Ecological Model: Insights From Thailand's Older Population

This study aimed to assess the burden of caregiving and identify factors predicting caregiver burden among family caregivers of community-dwelling older adults. Family caregivers of older adults face significant challenges in their caregiving responsibilities. Although some studies have examined factors related to caregiver burden among these caregivers, they are often limited in scope and frequently lack comprehensive theoretical frameworks and large population-based samples. This study conducted a secondary data analysis using the 7th Thailand National Survey of Older Persons from 2021. The analysis focused on 3192 dyads of older adults and their primary family caregivers. Primary family caregivers in this study generally experienced a mild burden. Higher caregiver burden was associated with leaving the workforce, being in an extended family, the older adult having poorer health, higher ADL dependency, age under 90 years, and poor hearing ability, and lack of community health worker visits. Addressing these findings can enhance nursing practices and health policies, providing more effective support to family caregivers and improving the well-being of both caregivers and older adults.

The relationship between stress, social support, and quality of life among spouses of patients at the end-of-life stage in Thailand: A correlational study

Background

Non-communicable diseases have become a leading global health challenge, with mortality rates steadily rising. Insufficient patient care can worsen chronic illness, often placing significant caregiving responsibilities on the patient's spouse. In some cases, spouses may need to leave their jobs to provide full-time care, especially during the end-of-life stage. Spousal caregivers often face emotionally distressing circumstances while caring for their loved ones, which can lead to elevated stress levels. However, research indicates that adequate social support can improve caregivers' quality of life, reducing some of the burdens associated with end-of-life care.

Objectives

This study aimed to assess and analyze the relationships between stress, social support, and quality of life experienced by spousal caregivers in Thailand, guided by Lazarus and Folkman's (1984) Stress and Coping Theory.

Methods

A correlational descriptive study design was used. The study was conducted with 84 spouses of patients in the end-of-life stage at a university hospital between October 2021 and March 2022. Data were collected using a questionnaire covering stress, social support, and quality of life and analyzed using Pearson's Product Moment and Spearman Rank Correlation Coefficients.

Results

The majority of spouses were women aged between 31 and 83 years (Mean = 61.24, SD = 10.42). The mean stress level was 6.40 (SD = 1.62), the mean social support was 55.07 (SD = 9.06), and the mean quality of life was 94.69 (SD = 10.04). There was no significant correlation between social support and stress (r = -0.098, p = 0.373). However, stress was negatively correlated with quality of life (r = -0.299, p = 0.006), and social support was positively related to quality of life (r = 0.219, p = 0.045).

Conclusion

Spousal caregivers of patients at the end-of-life stage experienced varying levels of stress, social support, and quality of life. While no significant relationship was found between social support and stress, stress negatively impacted quality of life, while higher social support was associated with improved quality of life. Healthcare providers, especially nurses, should assess and address the stress, social support, and overall well-being of spousal caregivers to enhance their quality of life.

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.

The mediating role of coping strategies between caregiving burden and pre-death grief among Chinese adult-child caregivers of dementia patients

AIMS

The objective of this study was to examine the relationship between caregiving burden and pre-death grief, with a specific focus on adult-child caregivers in mainland China. Additionally, the study explored whether coping strategies played a mediating role in this correlation.

METHODS

A convenience sample of 320 adult-child caregivers of older parents with dementia from Kunming, mainland China, was recruited for the study. Data were collected using the Chinese version of the Marwit-Meuser Caregiver Grief Inventory-Short Form, the Burden Scale for Family Caregivers, and the Ways of Coping Checklist-Revised.

RESULTS

Results using linear regression and multiple mediation analysis with Hayes' process model indicated that caregiving burden was positively related to pre-death grief and that active coping mediated the relationship between them. In the female group, active coping partially mediated the association between caregiving burden and pre-death grief, but in the male group, this mediating effect did not exist.

CONCLUSION

The study found evidence supporting the link between caregiving burden and pre-death grief among adult-child caregivers of older parents with dementia in mainland China. Furthermore, the caregiving burden prevented the use of active coping, and this decrease in coping increased the perception of pre-death grief. These associations only existed in the female group.

IMPLICATIONS

This paper presented the importance of active coping skills in the dementia caregiving process.

IMPACT

The findings of this study emphasize the necessity for health practitioners to provide targeted interventions regarding pre-death grief among dementia caregivers and strengthen caregivers' active coping strategies to reduce their pre-death grief. Community-based and personal care support services should be promoted to alleviate their caregiving burden.

REPORTING METHOD

We have adhered to the transparent reporting of evaluations with quantitative design statements and the corresponding checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Factors Influencing Caregivers' Use of Respite Care Services: Secondary Analysis of the National Study of Caregiving

This study examines when and why unpaid caregivers use respite services. We conducted a secondary analysis of the 2017 National Study of Caregiving (NSOC) Wave III, a U.S. nationally representative sample comprising 2652 unpaid caregivers. We found that unpaid caregivers reporting financial, physical, and emotional difficulties in caregiving were more likely to use respite care services than those not reporting these challenges. White, non-Hispanic caregivers reporting that they received support from their social networks (families/friends) were more likely to use respite care services than non-White and/or Hispanic caregivers receiving such support. Non-White and/or Hispanic caregivers who belonged to or attended support groups were more likely to use respite care support than those without social group affiliation. Respite care is underutilized in the U.S. despite its value and efficacy in supporting caregivers' mental and physical well-being. Policies are necessary to increase availability and access to respite services for diverse unpaid caregivers.

Walking Interventions and Sleep Quality of Persons Living With Dementia and Their Family Caregivers: Effects of Different Walking Companions

PURPOSE

To examine the effect of walking interventions on sleep quality of persons with dementia (PWD) and their caregivers (dyads), and how different companions affect results.

METHOD

Forty-five dyads were divided into three groups: a control group and two experimental groups (one with a care attendant, one with a family caregiver). The two experimental groups engaged in 120 minutes of walking per week for 24 weeks.

RESULTS

A significant improvement in sleep quality was observed among PWD in the family caregiver group (Wald χ2 = 4.55, p = 0.033), whereas there was no improvement in the care attendant group. A slight improvement in sleep quality of family caregivers was also found.

CONCLUSION

Findings suggest the importance of creating individualized walking activity plans for dyads, incorporating trust and rapport-building strategies to improve sleep quality. [Journal of Gerontological Nursing, 50(8), 46-56.].

Caring for a parent with dementia: The psychological well-being of adult children

BACKGROUND

Caregiving for a parent with dementia has both positive and negative influences on psychological well-being of adult children and perceived social support plays an essential role in dementia caregiving process.

OBJECTIVES

We examined how the degree of caregiving intensity influences mental health among Chinese adult children then further explored how perceived social support influences the relationship between intensity and psychological well-being.

RESEARCH DESIGN AND SETTING

Cross-sectional study in Kunming, mainland China between November 2022 and January 2023.

METHODS

We interviewed 320 adult dementia child caregivers. Linear regression and multiple mediation analysis using Hayes' process model were used to assess the relationship between caregiving intensity and psychological well-being, as well as the mediating role of perceived social support.

RESULTS

The study found that caregiving intensity was positively associated with depression and negatively associated with life satisfaction. A lack of perceived social support exacerbated these effects for the adult children. Specifically, the caregivers reported higher caregiving intensity when they perceived less family support, which is in turn associated with greater depression and lower life satisfaction among the caregivers. Likewise, those who reported higher caregiving intensity was reported lower friend support, which was in turn associated with greater depression.

CONCLUSIONS AND IMPLICATIONS

The findings emphasize the importance of social support, especially family support, and the necessity for health practitioners to provide targeted interventions on both negative and positive aspects of psychological well-being among dementia caregivers and to strengthen caregivers' resources for social support to enhance their well-being. While these findings are cross-sectional, it is logical to assume that those who perceive less support feel that their caregiving responsibilities are more intense, and that intensity could cause the caregiver to withdraw from friends.

Care dependency in older stroke patients with comorbidities: a latent profile analysis

Objectives

To explore latent profiles of care dependency in older stroke patients with comorbidities and to analyze the factors influencing different latent profiles.

Methods

A total of 312 older ischemic stroke patients with comorbidities were included in the analysis. Latent Profile Analysis (LPA) was used to classify the participants into potential subgroups with different types of care dependency. The influencing factors of the classification of care dependency subgroups were determined using multivariate Logistic regression analysis.

Results

The care dependency score of older ischemic stroke patients with comorbidities was (51.35 ± 13.19), and the patients could be classified into 3 profiles, namely Universal dependency (24.0%), Moderate activity-social-learning dependency (28.0%), and Mild activity-social-learning dependency (48.0%); caregiver, BI at admission, and functional impairments were independent factors influencing care dependency (P < 0.05).

Conclusion

There are three latent profiles of care dependency in older ischemic stroke patients with comorbidities. According to the characteristics of various populations, medical staff are able to implement specific interventions to lower the level of dependency and further improve the quality of life of patients.

Chronic Health Conditions and Patient Portal Use in Caregivers of People With Alzheimer's Disease and Related Dementias

This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities.

Mental Health Outcomes of Immigrant- and US-Born Caregivers: California Health Interview Survey, 2019-2020

Objectives. To compare the mental health outcomes of US-born with immigrant caregivers of adult care recipients. Methods. We conducted a cross-sectional secondary analysis of the 2019 California Health Interview Survey (CHIS), administered via web or telephone to 22 152 participants between September and December 2019. We characterized (1) caregivers and noncaregivers, and (2) US-born versus immigrant caregivers. Then, we estimated and compared (3) the relationship between caregiving status and severe psychological distress among US-born and immigrant respondents, and (4) correlates of severe psychological distress among US-born and immigrant respondents. Results. Caregivers were more likely than noncaregivers to report severe psychological distress (P < .05). Immigrant caregivers residing separately from their care recipient were significantly more likely to experience severe psychological distress (odds ratio = 3.76; P < .01). Conclusions. US-born and immigrant caregivers may experience different risk factors for psychological distress associated with caregiving. Clinical and community resources should be tailored to caregivers' distinct needs with consideration of how access to resources (e.g., language), circumstances (e.g., acculturation), and cultural norms (e.g., filial piety) may be associated with exacerbation of psychological distress among immigrants. (Am J Public Health. 2024;114(S2):S189-S199. https://doi.org/10.2105/AJPH.2023.307396).

Decoding Caregiver Burden in Cancer: Role of Emotional Health, Rumination, and Coping Mechanisms

This study aimed to elucidate the role of psychological factors in caregiver burden among caregivers of stage 4 cancer patients. Data were collected from 328 caregivers of cancer patients, employing the Zarit Care Burden Scale, Depression-Anxiety-Stress Scale (DASS-42), Dysfunctional Attitudes Scale (DAS-A), Ruminative Thought Style Questionnaire (RTSQ), and Coping Orientation to Problems Experienced Inventory (Brief COPE). Males, spouses, and caregivers of patients with a PEG or tracheostomy, or those diagnosed with pancreatic biliary cancer were found to have a significantly higher risk of caregiver burden. Age, sex, caregiver-patient relationship, caregiving duration, patient's catheter status, cancer types, depression and stress severity, rumination, dysfunctional attitudes, and dysfunctional coping strategies explained 69.7% of the variance in Zarit Care Burden Scale scores (F(14,313) = 51.457, p < 0.001), illustrating their significant predictive relationship with caregiver burden. Moderation analysis revealed significant interactions of emotional coping with depression (b = -0.0524, p = 0.0076) and dysfunctional coping with stress on caregiver burden (b = 0.014, p = 0.006). Furthermore, rumination mediated the relationships between caregiver burden, stress, and depression (p < 0.01). Overall, the results highlight the intricate relationships among caregiver burden, mental health, and coping strategies, suggesting tailored interventions to support caregiver health and quality of care.

Social Networks Effects on Spouse and Adult-Child Dementia Caregivers' Experiences: A Cross-Sectional Study

OBJECTIVES

A large body of literature addresses experiences of spouse and adult-children caregiver of individuals with dementia (IWDs) but has not examined the role and strength of social networks in associations between spouses and adult-children caregivers' experience. Based on the stress process model, we aimed to explore the strength levels of social networks and their association with spouses/adult-children caregivers for IWDs.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A questionnaire-based survey was conducted with a total of 146 family caregivers of IWDs (78 adult-child, and 68 spouses) in China.

METHODS

Data collection comprised 4 sections: (1) care-related stressors (dementia stage, neuropsychiatric symptoms); (2) caregiver context; (3) social network, using the Lubben Social Network Scale; and (4) caregiving experience, using the short-form Zarit Burden Interview and 9-item Positive Aspects of Caregiving Scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore the mechanisms of associations between variables.

RESULTS

Spouses had weaker social network strength (β = -0.294, P = .001) and reported greater positive aspects of caregiving (β = 0.234, P = .003) than adult-children caregivers; no significant difference was found between them for caregiver burden. Mediation analysis suggests that associations between caregiver type and caregiver burden are indirect-only mediation effects of social networks (β = 0.140, 95% CI = 0.066-0.228). The social network strength suppressed the association between caregiver type and positive aspects of caregiving. The caregiver type/social network interaction statistically significantly (P = .025) affected the "positive aspects": a stronger social network was associated with more positive aspects of caregiving among the spouse subgroup (β = 0.341, P = .003).

CONCLUSIONS AND IMPLICATIONS

Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

Identifying care problem clusters and core care problems of older adults with dementia for caregivers: a network analysis

Background

A shift in research interest from separate care problem to care problem clusters among caregivers of people living with dementia may contribute to a better understanding of dementia care. However, the care problems network among caregivers of people living with dementia are still unknown. This study aimed to identify care problem clusters and core care problems, and explore demographic variables associated with these care problem clusters among caregivers of people living with dementia.

Methods

Participants were recruited through memory clinics and WeChat groups. The principal component analysis was applied to identify care problem clusters. The network analysis was conducted to describe the relationships among care problems and clusters. Multiple linear models were used to explore the associated factors for the occurrence of the overall care problems and top three central care problem clusters.

Results

A total of 1,012 carer-patient pairs were included in the analysis. Nine care problem clusters were identified. In the entire care problem network, "deterioration in activities of daily living" was the most core care problem cluster across the three centrality indices, followed by "verbal and nonverbal aggression" and "loss of activities of daily living." Variables including marital status, years of dementia diagnosis, number of dementia medication type, and caregiver's educational attainment were associated with the prevalence of these three care problem clusters.

Conclusion

Our study suggests that there is a need to evaluate care problem clusters for the improvement of care problem management among people living with dementia. It is particularly important to include assessment and treatment of core care problem as an essential component of the dementia care.

Case Management-based Collaborative Care Model Associated with improvement in neuropsychiatric outcomes in community-dwelling people living with dementia

BACKGROUND

This study aimed to explore the association between adherence of collaborative care model and short-term deterioration of BPSD after controlling patient and caregiver factors.

METHODS

This retrospective case-control study enrolled 276 participants who were newly diagnosed with dementia and BPSD. A dementia collaborative care team interviewed patients and caregivers to form a care plan and provided individualized education or social resource referrals. A multivariate logistic regression model with backward selection was used to test factors associated with BPSD deterioration, defined as worse neuropsychiatric inventory (NPI) scores 1 year after joining the care model.

RESULTS

Male sex (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.25-0.84) and higher clinical dementia rating scale sum of boxes scores (CDR-SOB) (OR = 0.90; 95% CI = 0.83-0.98) were protective factors, whereas spouse caregivers and withdrawals from the care model (OR = 3.42; 95% CI = 1.28-9.15) were risk factors for BPSD deterioration.

CONCLUSIONS

Our study showed that both patient and caregiver factors were associated with deterioration of BPSD. The case manager-centered dementia collaborative care model is beneficial for the management of BPSD. Healthcare systems may consider implementing a case management model in clinical dementia care practice.

Partners' Experience of Informal Caregiving for Patients With Heart Failure: A Meta-ethnography

BACKGROUND

Individuals with heart failure (HF), a debilitating disease with ongoing adaptation and management, are often cared for by partner caregivers whose needs and voices are overshadowed by the demands of HF management. With multidimensional needs and complex challenges for individuals with HF, partner caregivers have to deal with uncertainty and need guidance. Given the vital role of partners, attention should be drawn toward understanding the experience of HF partner caregivers.

OBJECTIVE

The aim of this study was to synthesize existing qualitative evidence related to caregivers' views and experiences of caring for their partners with HF. This knowledge would assist healthcare providers to better meet the demand of partners and provide them with effective guidance.

METHODS

A meta-ethnography of qualitative evidence was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations for reporting systematic reviews. A comprehensive search of PubMed, Scopus, ISI Web of Science, CINAHL, PsycINFO, and EMBASE, as well as hand searches of the reference lists from included articles, was conducted. A combination of subject terms including MeSH and keywords related to HF, partner experience, and qualitative methods was used to identify studies. Studies were included if they were published in English between January 2000 and December 2020 and examined caregivers' experiences in providing care for their partner with HF by using qualitative methods.

RESULTS

Ten articles were included, with 178 participants, and most partners were female. Five studies were conducted in the United States, and 4 studies were conducted in Sweden. Five studies reported partners' health problems; 8 of the studies delineated the inclusion and exclusion criteria for partners. Five overarching themes emerged: shouldering the responsibility, being overloaded, bearing emotional burdens, staying positive, and "left in the dark," craving support from others.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Given the complex roles in caring for individuals with HF, more qualitative research is strongly warranted to enhance caregivers' support and education. A deeper and more comprehensive understanding of the experiences of caregivers for partners with HF is essential for developing tailored interventions. Healthcare providers should be aware of the importance of ongoing assessment and evaluate partner caregivers' needs and assist them in providing more information and formulating coping strategies as required.

The Burden of Next-of-Kin Carers of Dementia Sufferers in the Home Environment

The role and responsibilities of next-of-kin carers are significant, filling several years of their lives and causing them to experience a burden of care. This study was conducted to investigate the burden of next-of-kin carers for dementia sufferers in Slovakia. Data were compiled via the Relatives' Stress Scale (RSS) screening instrument through a survey of 112 primary next-of-kin carers and analysed using the statistical tests of descriptive statistics, means, scores and significance differences (Wilcoxon test). This is one of the few scales which provides: (a) specific measures of caregiver stress, and (b) is standardised for a population of informal carers in the home environment. The profiles of Slovak next-of-kin carers were identified with statistically significant characteristics (gender, age of carers). The study identified a high level of caregiving stress (82.15%), and selected factors were found to be significant in all burden dimensions: emotional stress (p = 0.001), social stress (p = 0.003), and negative feelings (p = 0.002). The results emphasise the need for coordination of healthcare and social services, possibly by expanding the network of social support groups, operating a counselling hotline/chat, and introducing national educational programmes for the next-of-kin carers of dementia sufferers. The results are also a source of reference for the umbrella organisation 'the Slovak Alzheimer's Society' to access when implementing changes at a national level.

Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis

Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.

Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

Background

Limited English proficiency (LEP) of dementia caregivers poses a critical barrier to these caregivers’ access to evidence-based interventions. In an effort to make such interventions available and accessible to dementia caregivers with LEP, in the present study we use Barrera and colleagues’ (2011) three-step model of cultural adaptation: (1) information gathering, (2) preliminary adaptation, and (3) full adaptation. Selecting Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target intervention, we demonstrate the sequential process of cultural adaption and report the outcomes on feasibility and acceptability.

Methods

Preliminary adaptation with linguistic attunement was conducted by translating the SCP manual into Korean and certifying two lay individuals who were bilingual in English and Korean as Savvy trainers. The 6-week online SCP program was delivered by the two trainers in Korean with six to seven caregiver participants per trainer (N = 13). Feasibility and acceptability of the SCP for both caregiver participants and trainers were assessed using mixed methods, and their data then informed full adaptation.

Results

Findings not only showed the initial efficacy of the linguistically attuned SCP but also suggested areas for further modification. Data-driven assessment yielded a list of recommended changes for full adaptation, which was reviewed by the SCP developer to ensure fidelity and by community and research partners to confirm contextual and cultural relevance.

Conclusions

The adopted changes are broadly summarized as representing logistical, technical, and cultural issues. Given our refined set of educational materials and implementation guidelines, we discuss future directions for research and development.

Quality of Life and Related Outcomes Among Unpaid Caregivers of Older Adults With Visual Impairment

Caregivers of older adults with visual impairments are often family members who spend many hours caring for loved ones at the expense of their personal needs. The purpose of this study was to examine the quality of life of unpaid caregivers of older adults with visual impairments and determine the barriers and facilitators for improving their quality of life. To examine this population, 130 unpaid caregivers of older adults with visual impairments were surveyed using the Satisfaction with Life Scale, Living Arrangement and Indicators of Social Interaction Survey, the Geriatric Depression Scale (GDS), Caregiver Quality of Life (EQ-5D), and the Perceived Change Index (PCI). Results revealed that the unpaid caregivers face many challenges, but inexperience/difficulty with tasks and balancing their personal life were the biggest obstacles. Interventions could help improve quality of life and well-being as well as provide support services and access to community resources to reduce the family caregiver burden.

Cultural adaptation of World Health Organization iSupport for Dementia program for Chinese-Australian caregivers

BACKGROUND

Home-based dementia care is common in the Chinese-Australian community. However, dementia education programs for Chinese-Australians in the language of their choice are scarce. The World Health Organization has developed iSupport for Dementia, an online education program for informal caregivers. Cultural adaptation of the program for Chinese-Australian caregivers is an opportunity to address this gap in caregiver support.

AIM

The aims of the study were (1) to understand stakeholders' perspectives on the cultural and linguistic appropriateness of the Chinese iSupport for Dementia content and design and (2) to explore factors affecting the future implementation of the Chinese iSupport program in Australia.

METHODS

A qualitative descriptive design was applied to address the aims of the study. Focus group discussions with Chinese-Australian caregivers and community aged care workers were conducted to collect data. Thematic analysis was used to analyse data.

RESULTS

In total, six focus groups were conducted with 18 Chinese-Australian caregivers and 17 care workers. Six themes were identified and described as follows: (1) appropriateness of the Chinese iSupport content; (2) acceptability of the online Chinese iSupport design; (3) motivations to engage in the iSupport program; (4) desire to interact with peers and professional facilitators; (5) concerns about program accessibility; and (6) the need to extend the iSupport program to care workers.

CONCLUSIONS

Engagement with Chinese-Australian caregivers and care workers will inform further revisions of the Chinese iSupport program contents to ensure the program is culturally congruent to Chinese-Australian caregivers. Factors affecting the implementation of the program identified in the study will be considered in the intervention phase of the program.

Dyadic effects on depressive symptoms of spouse caregivers and their care recipients: evidence from China

OBJECTIVES

The likelihood of providing care to a spouse in middle and older ages has increased as life expectancy increases, but knowledge about how the caregiver and care recipient influence each other's mental health is limited. This study examined whether a partner's physical, cognitive, and mental health in a spousal caregiving dyad are associated with the other partner's depressive symptoms in China and whether the dyadic effects vary by gender.

METHODS

This study used data from Wave 3 (2015) and Wave 4 (2018) follow-up surveys of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample featured 1,245 dyads of care recipients aged 45 or older and their spouse caregivers. The Actor-Partner Interdependence Model was used to test the dyadic effects among all couples in the analytic sample, couples with wife caregivers and couples with husband caregivers, respectively.

RESULTS

We found that caregiver's depressive symptoms at Wave 3 were significantly associated with care recipient's depressive symptoms at Wave 4 in the full sample. Regardless of caregiver or care recipient roles, wives' mental health was impacted by their husbands' depressive symptoms, but not vice versa. Wife recipient's cognitive impairment was associated with husband caregiver's lower depressive symptoms.

CONCLUSION

This study sheds light on the mental health of couples in the context of caregiving in China. The findings indicate that interventions to support couples in a caregiving dyad need to consider the influence they have on each other, and the gender and health conditions of each in the dyad.