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Ikanga J, Reyes A, Zhao L, Hill-Jarrett TG, Hammers D, Epenge E, Esambo H, Kavugho I, Esselakoy C, Gikelekele G, Tshengele N, Alonso A, Robinson-Lane SG. Exploring factors contributing to caregiver burden in family caregivers of congolese adults with suspected dementia. Int J Geriatr Psychiatry 2023; 38:e6004. [PMID: 37712695 PMCID: PMC10901182 DOI: 10.1002/gps.6004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Predicting caregiver burden in individuals with suspected dementia - is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub-Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC). METHODS Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient-caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI). RESULTS Average caregiver burden on the ZBI was 36.1 (SD = 14.6; range = 12-58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden. CONCLUSION Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden.
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Affiliation(s)
- Jean Ikanga
- Emory University School of Medicine, Department of Rehabilitation Medicine, Georgia, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Anny Reyes
- Emory University School of Medicine, Department of Rehabilitation Medicine, Georgia, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Liping Zhao
- Emory University, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta GA 30322, USA
| | - Tanisha G. Hill-Jarrett
- University of South Florida, Department of Neurosurgery and Brain Repair, Tampa, Florida, 33613, USA
- University of California, Global Brain Health Institute, San Francisco, California, 94158, USA
| | - Dustin Hammers
- Indiana university, department of neurology, Indiana, Indianapolis, IN 46202, USA
| | - Emmanuel Epenge
- University of Kinshasa, department of neurology, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Herve Esambo
- University of Kinshasa, department of neurology, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Immaculée Kavugho
- Memory Clinic of Kinshasa, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Christian Esselakoy
- University of Montreal, Department of psychology, PO BOX 6128 Centre-ville STN Montreal QC H3C 3J, CANADA
| | - Guy Gikelekele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Nathan Tshengele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Alvaro Alonso
- Emory University, School of Public Health, department of epidemiology, Georgia, Atlanta, GA, 30307, USA
| | - Sheria G. Robinson-Lane
- University of Michigan, School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, Michigan, 48109, USA
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Geerlings AD, Kapelle WM, Sederel CJ, Tenison E, Wijngaards-Berenbroek H, Meinders MJ, Munneke M, Ben-Shlomo Y, Bloem BR, Darweesh SKL. Caregiver burden in Parkinson's disease: a mixed-methods study. BMC Med 2023; 21:247. [PMID: 37424022 PMCID: PMC10332089 DOI: 10.1186/s12916-023-02933-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Providing informal care for a person with Parkinson's disease (PD) can be a demanding process affecting several dimensions of a caregiver's life and potentially causing caregiver burden. Despite the emerging literature on caregiver burden in people with PD, little is known about the inter-relationship between quantitative and qualitative findings. Filling this knowledge gap will provide a more holistic approach to develop and design innovations aiming at reducing or even preventing caregiver burden. This study aimed to characterize the determinants of caregiver burden among informal caregivers of persons with PD, in order to facilitate the development of tailored interventions that reduce caregiver burden. METHODS We conducted a cross-sectional study in The Netherlands using a sequential mixed methods approach, entailing a quantitative study of 504 persons with PD and their informal caregivers as well as a qualitative study in a representative subsample of 17 informal caregivers. The quantitative study included a standardized questionnaire of caregiver burden (Zarit Burden Inventory) and patient-related (Beck Depression Inventory, State-Trait Anxiety Inventory, Acceptance of Illness Scale, MDS-Unified Parkinson's Disease Rating Scale part II on motor functions in daily life, Self-assessment Parkinson's Disease Disability Score), caregiver-related (Brief Coping Orientation to Problems Experience Inventory, Caregiver Activation Measurement, Multidimensional Scale of Perceived Social Support) and interpersonal determinants (sociodemographic variables including among others gender, age, education, marital status and working status). The qualitative study consisted of semi-structured interviews. Multivariable regression and thematic analysis were used to analyse quantitative and qualitative data, respectively. RESULTS A total of 337 caregivers were women (66.9%), and the majority of people with PD were men (N = 321, 63.7%). The mean age of persons with PD was 69.9 (standard deviation [SD] 8.1) years, and the mean disease duration was 7.2 (SD 5.2) years. A total of 366 (72.6%) persons with PD had no active employment. The mean age of informal caregivers was 67.5 (SD 9.2) years. Most informal caregivers were female (66.9%), had no active employment (65.9%) and were the spouse of the person with PD (90.7%). The mean Zarit Burden Inventory score was 15.9 (SD 11.7). The quantitative study showed that a lack of active employment of the person affected by PD was associated with a higher caregiver burden. The qualitative study revealed cognitive decline and psychological or emotional deficits of the person with PD as additional patient-related determinants of higher caregiver burden. The following caregiver-related and interpersonal determinants were associated with higher caregiver burden: low social support (quantitative study), concerns about the future (qualitative study), the caregiving-induced requirement of restrictions in everyday life (qualitative study), changes in the relationship with the person with PD (qualitative study) and a problem-focused or avoidant coping style (both studies). Integration of both data strands revealed that qualitative findings expanded quantitative findings by (1) distinguishing between the impact of the relationship with the person with PD and the relationship with others on perceived social support, (2) revealing the impact of non-motor symptoms next to motor symptoms and (3) revealing the following additional factors impacting caregiver burden: concern about the future, perceived restrictions and limitations in performing daily activities due to the disease, and negative feelings and emotional well-being. Qualitative findings were discordant with the quantitative finding demonstrating that problem-focused was associated with a higher caregiver burden. Factor analyses showed three sub-dimensions of the Zarit Burden Inventory: (i) role intensity and resource strain, (2) social restriction and anger and (3) self-criticism. Quantitative analysis showed that avoidant coping was a determinant for all three subscales, whereas problem-solved coping and perceived social support were significant predictors on two subscales, role intensity and resource strain and self-criticism. CONCLUSIONS The burden experienced by informal caregivers of persons with PD is determined by a complex interplay of patient-related, caregiver-related and interpersonal characteristics. Our study highlights the utility of a mixed-methods approach to unravel the multidimensional burden experienced by informal caregivers of persons with chronic disease. We also offer starting points for the development of a tailored supportive approach for caregivers.
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Affiliation(s)
- Angelika D Geerlings
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Willanka M Kapelle
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Charlotte J Sederel
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Marjan J Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101 (Internal Code 914), 6500 HB, Nijmegen, The Netherlands.
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Adebisi AT, Salawu MA. Misconception of dementia-related disorders in Sub-Saharan Africa. Front Neurol 2023; 14:1148076. [PMID: 37139060 PMCID: PMC10149925 DOI: 10.3389/fneur.2023.1148076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Abdulyekeen T. Adebisi
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu, Republic of Korea
- *Correspondence: Abdulyekeen T. Adebisi
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A systematic review and narrative synthesis of the experiences with caring for older people living with dementia in Sub-Saharan Africa. BMC Geriatr 2022; 22:961. [PMID: 36514016 PMCID: PMC9749146 DOI: 10.1186/s12877-022-03668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, including sub-Saharan Africa little is known about the experiences with caring for people living with dementia. The purpose of this systematic review and narrative synthesis was to examine the experiences with caring for older people living with dementia at home. RESULTS In total, 366 abstracts were identified and following screening, 19 studies were included in the synthesis. Six themes were identified: conceptualising dementia, caregiving arrangements, the impact of caregiving, caregiver identity and role, managing caregiving, unmet caregiver needs. CONCLUSION There is a dearth of research in relation to caregiving for older people living with dementia in sub-Saharan Africa. There is need for better information campaigns and support programs directed at family and professional caregivers in this context.
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Onohuean H, Akiyode AO, Akiyode O, Igbinoba SI, Alagbonsi AI. Epidemiology of neurodegenerative diseases in the East African region: A meta-analysis. Front Neurol 2022; 13:1024004. [PMID: 36468051 PMCID: PMC9718573 DOI: 10.3389/fneur.2022.1024004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION There is a scarcity of epidemiological data on neurodegenerative diseases (NDs) in East Africa. This meta-analysis provides the regional prevalence of NDs, their contributing factors, and evidence of change over time concerning gender per age or year. METHODS Articles were retrieved from electronic databases following the PRISMA standard. RESULTS Forty-two studies were reviewed, and 25 were meta-analyzed with a random-effects model. The pool estimate proportion of 15.27%, 95% CI (0.09-0.23) (I2 = 98.25%), (Q = 1,369.15, p < 0.0001) among a population of 15,813 male/female and 1,257 with NDs. Epidemiological characteristics associated with NDs include Dyskinesias prevalence 55.4%, 95% CI (13.5; 90.9), I2 (96%) and subsistence farming prevalence 11.3%, 95% CI (5.8; 20.9), I2 (99%). Publication bias by Egger test was (z = 4.1913, p < 0.0001), while rank correlation test using Kendall's model was (tau = 0.1237, p = 0.3873). Heterogeneity (R2 design = 5.23%, p design < 0.0001; R2 size = 52.163%, p size < 0.001; and R2 period = 48.13, p period < 0.0001. Covariates (R2 design + size + period = 48.41%, p < 0.001). CONCLUSION There is a high prevalence of NDs in the East African region, which could impact life expectancy, morbidity, and quality of life. Thus, early screening and regular surveillance could assist in management strategies.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
| | - Abraham Olutumininu Akiyode
- Department of Biology, College of Arts and Sciences, University of Texas of the Permian Odessa, TX, United States
| | - Oluwole Akiyode
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Biological and Environmental Sciences Department, Kampala International University, Kampala, Uganda
| | - Sharon Iyobor Igbinoba
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abdullateef Isiaka Alagbonsi
- Department of Clinical Biology (Physiology Unit), School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
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Ainamani HE, Bamwerinde WM, Rukundo GZ, Tumwesigire S, Mfitumukiza V, Bikaitwoha EM, Tsai AC. Fruit and vegetable intake and mental health among family caregivers of people with dementia in Uganda. MENTAL HEALTH & PREVENTION 2021; 24:None. [PMID: 34900574 PMCID: PMC8641063 DOI: 10.1016/j.mhp.2021.200223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 10/11/2021] [Indexed: 01/09/2023]
Abstract
Consumption of fruits and vegetables is correlated with improved mental wellbeing. Although this growing body of research has been recognized by researchers and clinicians in high-income countries, fewer studies examining this relationship have been conducted in low- and middle-income settings. In this study, we sought to estimate the association between fruit and vegetable intake and symptoms of depression and anxiety. We conducted a cross-sectional study among 242 family caregivers of people with dementia in southwestern Uganda. Fruit and vegetable intake in the past week was measured with a food frequency questionnaire. Depression and anxiety were assessed using the depression and anxiety subscales of the 42-item Depression, Anxiety and Stress Scales. Multivariable regression models were used to estimate the associations between fruits and vegetable consumption and depression and anxiety, adjusting for caregiving burden and other potential confounders. Depression symptom severity was negatively associated with consumption of jackfruits (b =-4.68; 95% confidence interval [CI], -8.96 to -0.39), green leafy vegetables (b =-14.1; 95% CI, -18.0 to -10.1), root vegetables (b =-14.0; 95% CI, -19.5 to -8.63), and other vegetables (b =-14.8; 95% CI, -19.3 to -10.3), and frequent consumption of vegetables (b =-1.91; 95% CI, -3.77 to -0.04). Anxiety symptom severity was negatively associated with consumption of green leafy vegetables (b =-12.2; 95% CI, -16.0 to -8.46), root vegetables (b=-12.6; 95% CI, -17.5 to -7.58), and other vegetables (b =-12.7; 95% CI, -17.0 to -8.40), and frequent consumption of vegetables (b =-2.07; 95% CI, -3.84 to -0.29). Our results suggest that fruit and vegetable consumption is associated with reduced depression and anxiety symptoms.
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Affiliation(s)
- Herbert E Ainamani
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda, P. O. Box 317
| | - Wilson M Bamwerinde
- Department of Environment and Natural Resources Kabale University, Kabale, Uganda
| | - Godfrey Z Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sam Tumwesigire
- Department of Pediatrics, Kabale University School of Medicine, Kabale, Uganda
| | | | - Everd M Bikaitwoha
- Department of Pediatrics, Kabale University School of Medicine, Kabale, Uganda
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, United States
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Fothergill-Misbah N, Walker R, Kwasa J, Hooker J, Hampshire K. "Old people problems", uncertainty and legitimacy: Challenges with diagnosing Parkinson's disease in Kenya. Soc Sci Med 2021; 282:114148. [PMID: 34153822 DOI: 10.1016/j.socscimed.2021.114148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023]
Abstract
Very little is known about the experience of people living with Parkinson's disease (PD) in low- and middle-income countries, such as those in sub-Saharan Africa. The number of specialists in the region is low and awareness is limited among the population and healthcare professionals. Drawing on ten months of ethnographic fieldwork in urban and rural Kenya with 55 people living with PD (PwP), 23 family members and 22 healthcare professionals from public and private clinics, we set out to understand the experience of diagnosis among PwP in Kenya. The diagnostic journeys of our study participants were typically long, convoluted and confusing. Lack of relevant information, combined with comorbidities and expectations about 'normal' ageing, often conspired to delay interactions with health services for many. There often followed an extended period of diagnostic uncertainty, misdiagnosis and even 'undiagnosis', where a diagnostic decision was reversed. Following diagnosis, patients continued to lack information about their condition and prognosis, making it difficult for friends, family members and others to understand what was happening to them. We suggest that awareness of PD and its symptoms needs to improve among the general population and healthcare professionals. However, diagnosis is only the first step, and needs to be accompanied by better access to information, affordable treatment and support.
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Affiliation(s)
| | - Richard Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Judith Kwasa
- Department of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Kate Hampshire
- Department of Anthropology, Durham University, Durham, United Kingdom
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Ainamani HE, Alele PE, Rukundo GZ, Maling S, Wakida EK, Obua C, Tsai AC. Caring for people with dementia in rural Uganda: qualitative study of caregiving burden experienced by informal and formal caregivers. JOURNAL OF GLOBAL HEALTH REPORTS 2020; 4. [PMID: 33043153 PMCID: PMC7544160 DOI: 10.29392/001c.12848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background The rising incidence of Alzheimer's disease among older-age adults worldwide has been accompanied by an increase in caregiving burden. Limited work has examined the lived experiences of both formal and informal caregivers of people living with dementia in low-income countries. Methods We conducted one-on-one, in-depth qualitative interviews with a purposive sample of 10 informal caregivers and 5 formal caregivers of people living with dementia in Mbarara, Uganda. They were interviewed about their experiences caring for people with dementia until thematic saturation was reached. All interviews were audio recorded, transcribed into English, and thematically analysed. Results Two primary themes emerged from the data: patient factors influencing caregiving burden (problematic behaviours, such as wandering and aggression) and patient physical health and cognitive deterioration (namely, loss of memory and incontinence). Psychosocial and economic aspects of caregiving burden included financial costs, family conflicts, anxiety, stigma, and substance misuse. Conclusions Both formal and informal caregivers of people living with dementia experience physical, financial, and psychological stressors. Interventions aimed at reducing these stressors would benefit caregivers as well as improve quality of care for people living with dementia.
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Affiliation(s)
- Herbert E Ainamani
- Mbarara University of Science and Technology, Mbarara, Uganda; Bishop Stuart University, Mbarara, Uganda; Kabale University School of Medicine, Kabale, Uganda
| | - Paul E Alele
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Samuel Maling
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda; Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
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Caregiving burden and mental health problems among family caregivers of people with dementia in rural Uganda. Glob Ment Health (Camb) 2020; 7:e13. [PMID: 32742671 PMCID: PMC7379317 DOI: 10.1017/gmh.2020.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/07/2020] [Accepted: 04/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda. METHOD We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest. RESULTS Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34-0.49] and anxiety (b = 0.37; 95% CI 0.30-0.45). CONCLUSION Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
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Faronbi JO, Faronbi GO, Ayamolowo SJ, Olaogun AA. Caring for the seniors with chronic illness: The lived experience of caregivers of older adults. Arch Gerontol Geriatr 2019; 82:8-14. [PMID: 30710847 PMCID: PMC6459393 DOI: 10.1016/j.archger.2019.01.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/27/2018] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Caregivers of the elderly with chronic illnesses are exposed to the burden associated with their caregiving activities. This study described the lived experience of caregivers of older adults in Nigeria. METHODS A qualitative design guided by interpretive phenomenology informed the design of the research, whereby 15 in-depth interviews were conducted with caregivers of older adults with chronic illnesses. The interview sessions were audiotaped and transcribed verbatim and analysed using constant comparison analysis method. RESULTS Fifteen caregivers, from different parts of Osun State, Nigeria, took part in the in-depth interviews. The caregivers were aged between 19 and 70 years, ten were women, five of them had secondary education, seven were self-employed and six were in a spousal relationship. The study uncovered four interrelated themes with explanatory subthemes-commitment to preservation of life (managing challenges associated with daily routine, problem with mobility, bathing and grooming, feeding, and problem with hygiene) (ii) denial (refusal to accept that burden exists), other things suffer (disruption of family process, suffering from poor health and social isolation), (iv) reciprocity of care (pride in caregiving, caregiving as a necessity and not by choice, and law of karma). CONCLUSION This study provides insight into the burden of care of older adults with chronic illness. Caregivers' commitment to preserving life makes them provide assistance whose performance even run contrary to their own wellbeing. Intervention programme should be designed to support the caregivers thereby improving their wellbeing.
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Affiliation(s)
- Joel Olayiwola Faronbi
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Grace Oluwatoyin Faronbi
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sunday Joseph Ayamolowo
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adenike Ayobola Olaogun
- Department of Nursing Science, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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The influence of caregivers' burden on the quality of life for caregivers of older adults with chronic illness in Nigeria. Int Psychogeriatr 2017; 29:1085-1093. [PMID: 28287058 DOI: 10.1017/s1041610216002295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND This study investigated the impact of caregivers' burden on health-related quality of life (HRQoL) among the caregivers of older adults, and tested the predictive effect of burden and socio-demographic factors on HRQoL. METHODS The study employed a cross-sectional design. Three hundred and twenty-five caregivers of older adults with chronic illness were purposively selected. Data were collected using the Zarit Burden Interview and Short Form (SF-36) Health Survey. Data were analyzed descriptively and inferentially. RESULTS Findings revealed that 59.1% of caregivers experienced severe burden. In measuring the HQRoL, respondents performed poorly in seven domains: Role limitation due to emotional problems (19.69 ± 9.46), Energy/fatigue (43.47 ± 16.46), Emotional well-being, (45.83 ± 13.93), Social functioning (49.09 ± 18.46), Role limitation due to physical function (43.33 ± 10.15), Physical functioning (43.6 ± 18.73), and General health (37.31 ± 12.09). Respondents, however, showed a higher score in the pain domain (56.77 ± 35.79). Furthermore, findings revealed a positive correlation between caregivers' burden and General health (r = 0.342), Emotional well-being (r = 0.222), and Physical functioning (r = 0.083). Similarly, there is a negative correlation between caregivers' burden and Social functioning (r = -0.618), Role limitation due to physical activities (r = 0.459), Role limitation due to emotional well-being (r = -0.530), and Energy/fatigue domains (r = -0.509). In addition, burden of caregiving (β=-3.142119, p = 0.000) and age (β=0.612752, p = 0.011) are predictors of the quality of life of caregivers. DISCUSSION This study concluded that there is a high prevalence of caregivers' burden resulting in poor HQRoL. In addition, burden and age are predictors of the quality of life of caregivers.
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Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design. Int Psychogeriatr 2017; 29:979-989. [PMID: 28222815 DOI: 10.1017/s1041610217000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. METHODS Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. RESULTS Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. CONCLUSIONS This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.
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Burke T, Galvin M, Pinto-Grau M, Lonergan K, Madden C, Mays I, Carney S, Hardiman O, Pender N. Caregivers of patients with amyotrophic lateral sclerosis: investigating quality of life, caregiver burden, service engagement, and patient survival. J Neurol 2017; 264:898-904. [PMID: 28280986 DOI: 10.1007/s00415-017-8448-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
Few studies in amyotrophic lateral sclerosis (ALS) have profiled disease-specific features of the condition in conjunction with assessment of caregivers' burden, distress, quality of life, and investigated patient survival. Eighty-four ALS patients and their primary caregivers were enrolled. Patients completed ALS-specific measures of physical and cognitive function, while caregivers completed measures of anxiety, depression, caregiver burden, and quality of life. Patient-caregiver dyads were interviewed about their health-service utilisation. Survival data were obtained through the Irish register for ALS. Participants were dichotomised into low/high groups according to the severity of self-reported caregiver burden, based on statistically derived cut-off scores. High-burdened caregivers (n = 43) did not significantly differ from low-burdened caregivers (n = 41) with respect to disease-specific characteristics, i.e., ALSFRS-R, bulbar- or spinal-onset ALS, disease duration, or survival data. However, significant differences were reported on subjective measures of anxiety (p < 0.000), depression (p < 0.001), distress (p < 0.000), and quality of life (p < 0.000). These data demonstrate the limited impact of ALS patient-related variables, i.e., ALSFRS-R and onset, on caregiver burden in ALS, and identify the importance of the psychological composition of caregivers. This study suggests that the subjective experience of individual caregivers is an important factor influencing the severity of experienced caregiver burden.
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Affiliation(s)
- Tom Burke
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.
| | - Miriam Galvin
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Marta Pinto-Grau
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Katie Lonergan
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Caoifa Madden
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Iain Mays
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Sile Carney
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Niall Pender
- Department of Psychology, Lower Ground Floor, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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14
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Farajzadeh A, Akbarfahimi M, Maroufizadeh S, Rostami HR, Kohan AH. Psychometric properties of Persian version of the Caregiver Burden Scale in Iranian caregivers of patients with spinal cord injury. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2016.1258738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ata Farajzadeh
- Department of Occupational therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malahat Akbarfahimi
- Department of Occupational therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hamid Reza Rostami
- Department of Occupational therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hassan Kohan
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Mkenda S, Olakehinde O, Mbowe G, Siwoku A, Kisoli A, Paddick SM, Adediran B, Gray WK, Dotchin CL, Adebiyi A, Walker RW, Mushi D, Ogunniyi A. Cognitive stimulation therapy as a low-resource intervention for dementia in sub-Saharan Africa (CST-SSA): Adaptation for rural Tanzania and Nigeria. DEMENTIA 2016; 17:515-530. [DOI: 10.1177/1471301216649272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cognitive stimulation therapy is a non-pharmacological intervention for people with dementia. Its use has been associated with substantial improvements in cognition and quality of life in studies from high-income countries, equivalent to those achieved by pharmacological treatments. Cognitive stimulation therapy may be particularly suited to low resource settings, such as sub-Saharan Africa, because it requires little specialist equipment and can be delivered by non-specialist health workers. The aim of this study was to adapt cognitive stimulation therapy for use in sub-Saharan Africa taking into account socio-cultural differences and resource implications. Methods Cognitive stimulation therapy is a structured programme, originally developed in the United Kingdom. Substantial adaptations were required for use in sub-Saharan Africa. The formative method for adapting psychotherapy was used as a framework for the adaption process. The feasibility of using the adapted cognitive stimulation therapy programme to manage dementia was assessed in Tanzania and Nigeria in November 2013. Further adaptations were made following critical appraisal of feasibility. Results The adapted cognitive stimulation therapy intervention appeared feasible and acceptable to participants and carers. Key adaptations included identification of suitable treatment settings, task adaptation to accommodate illiteracy and uncorrected sensory impairment, awareness of cultural differences and usage of locally available materials and equipment to ensure sustainability. Conclusions Cognitive stimulation therapy was successfully adapted for use in sub-Saharan Africa. Future work will focus on a trial of cognitive stimulation therapy in each setting.
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Affiliation(s)
- Sarah Mkenda
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Godfrey Mbowe
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Adesola Ogunniyi
- University College Hospital (University of Ibadan), Ibadan, Nigeria
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16
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Mokaya J, Dotchin CL, Gray WK, Hooker J, Walker RW. The Accessibility of Parkinson's Disease Medication in Kenya: Results of a National Survey. Mov Disord Clin Pract 2016; 3:376-381. [PMID: 30363517 DOI: 10.1002/mdc3.12294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/28/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background There is a dearth of knowledge about the availability and affordability of the different drug treatments for Parkinson's disease (PD) across sub-Saharan Africa (SSA). We aimed to determine the availability and affordability of drugs for treating PD in Kenya. Methods A facility-based survey was conducted in selected medicine outlets (pharmacies) in what were formerly the headquarter towns of the eight provinces of Kenya. We used the World Health Organization/Health Action International methodology to obtain data for drugs used to treat PD. Unit price for each drug was obtained. Results Forty-eight outlets were visited in total, six in each of Kenya's eight provinces. Levodopa (L-dopa) was available in only 24 (50.0%) outlets. Only one public pharmacy sold l-dopa (14 were private and nine were other types of outlet). Ergot-derived dopamine agonists (DAs) and anticholinergics were available in 37 and 35 outlets, respectively. Monoamine-oxidase inhibitors, non-ergot-derived DAs, and catechol-O-methyl transferase inhibitors were available in four, two and zero outlets, respectively. Mean cost of 100 l-dopa tablets was $48.2, though costs varied widely (range, $28.2-$82.4). Only five outlets considered l-dopa affordable, all of which sold 100 tablets for less than $31. Conclusion There is a lack of availability of PD drugs in Kenya, particularly in public pharmacies, where costs are generally lower. Few pharmacists consider the drugs available to be affordable. If PD is to be effectively managed in Kenya, then strategies are needed to increase the availability and affordability of medication.
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Affiliation(s)
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute for Ageing Newcastle University Newcastle upon Tyne United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute of Health and Society Newcastle University Newcastle upon Tyne United Kingdom
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17
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Rates and predictors of three-year mortality in older people in rural Tanzania. Arch Gerontol Geriatr 2015; 62:36-42. [PMID: 26549489 DOI: 10.1016/j.archger.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are few data on mortality rates in the general elderly living in sub-Saharan Africa. We aimed to detail three-year mortality rates in a population of rural community-dwelling older adults in northern Tanzania. METHODS We performed a community-based study of 2232 people aged 70 years and over living in Hai district, Tanzania. At baseline, participants underwent clinical assessment for disability, neurological disorders, hypertension, atrial fibrillation and memory problems. At three-year follow-up mortality data were collected. Mortality rates were compared to UK estimates. RESULTS At follow-up, data were available for 1873 subjects (83.9%). Of those, 208 (11.1%, 95% CI 9.7-12.5) had died. The age-standardised mortality rate was 10.2% (95% CI 8.8-11.6). Age-standardised mortality rates were lower than estimated for the UK (13.9%). In Cox regression analysis, greater age, higher levels of functional disability, use of a walking aid, subjective report of memory problems, being severely underweight and being normotensive were significant predictors of mortality. CONCLUSIONS Those who survive to old age in Tanzania appear to have relatively low mortality rates. Physical and cognitive disabilities were strongly associated with mortality risk in this elderly community-dwelling population. The association between blood pressure and mortality merits further study.
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Harding R, Gao W, Jackson D, Pearson C, Murray J, Higginson IJ. Comparative Analysis of Informal Caregiver Burden in Advanced Cancer, Dementia, and Acquired Brain Injury. J Pain Symptom Manage 2015; 50:445-52. [PMID: 25912274 DOI: 10.1016/j.jpainsymman.2015.04.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Measurement and improvement of informal caregiver burden are central aims of policy and intervention. Burden itself is a complex construct, and total burden can differ by patient diagnosis, although how diagnosis affects different aspects of caregiver subjective burden is unclear. OBJECTIVES To compare the subjective burden of caregivers across three diagnostic groups using the 22-item Zarit Burden Inventory. METHODS We performed a secondary analysis of pooled cross-sectional data from four U.K. studies of informal caregivers of patients with advanced cancer (n = 105), dementia (n = 131), and acquired brain injury (ABI) (n = 215). Zarit Burden Inventory totals, subscales (personal and role strain), and individual mean scores were compared between diagnostic groups using the general linear model, adjusting for caregiver characteristics. RESULTS Caregiver age (mean years [SD]: cancer 66.1 [12.0]; dementia 61.9 [13.4]; and ABI 53.8 [10.9]) differed significantly across diagnostic groups (P < 0.001); 81.9%, 36.6%, and 59.1% of caregivers were spouse/partners, respectively (P < 0.001). Total burden was highest in ABI caregivers and lowest in cancer (mean total score [SD]: cancer 23.3 [13.4]; dementia 27.9 [16.4]; and ABI 39.1 [17.3]) (P < 0.001). Subscale scores showed similar patterns (mean personal and role subscale scores [SD]: cancer 11.8 [6.9], 5.8 [4.8]; dementia 14.4 [8.8], 7.3 [5.7]; and ABI 18.7 [9.1], 11.8 [6.0]) (P < 0.001 for both subscales). Most (17 of 22) individual item scores differed by diagnosis group (P < 0.05), except concepts of duty, responsibility, and perception of financial situation. CONCLUSION Our data show that total, subscale, and most individual elements of caregiver subjective burden differ between cancer, dementia, and ABI caregivers. This should be considered when designing future intervention strategies to reduce caregiver burden in these groups.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Diana Jackson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Clare Pearson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Joanna Murray
- Health Service & Population Research, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
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Paddick SM, Kisoli A, Longdon A, Dotchin C, Gray WK, Chaote P, Teodorczuk A, Walker R. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry 2015; 30:815-23. [PMID: 25351844 DOI: 10.1002/gps.4218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms (BPS) in dementia are common in high-income countries, but there are few data from sub-Saharan Africa. Our aim was to estimate the prevalence and pattern of BPS and associated caregiver distress in rural Tanzania. METHODS Prevalent cases of dementia (aged 70 and over) were identified during a community-based door-to-door study in six rural villages in Tanzania. Following cognitive screening, a stratified sample (over-sampled for people with dementia) of cases underwent a detailed clinical assessment including the brief 12 item neuropsychiatric inventory (NPI-Q), which assesses BPS and associated caregiver distress over the preceding 30 days. RESULTS Of 78 people with dementia, at least one current BPS was reported by 69 (88.4%), with 40 (51.3%) reporting 3 or more symptoms. In 172 people with no cognitive impairment, 110 (64.0%) reported at least one symptom and 48 (27.9%) reported 3 or more. In dementia cases, the most frequent symptoms reported were anxiety (47.4%), agitation/aggression (38.5%), night-time behavioural disturbance (34.6%), irritability (33.3%) and depression (33.3%). CONCLUSION The frequency of BPS in dementia in this rural Tanzanian population is high and comparable to that reported in prevalence studies from high income countries. Symptoms were also common, although to a lesser degree, amongst cognitively intact subjects. BPS are likely to have a significant impact on quality of life for elderly persons and their carers in low-income settings. Low-cost interventions, such as community-based therapy and education, are needed.
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Affiliation(s)
- S-M Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - A Kisoli
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Longdon
- South Devon Healthcare Trust, Torquay, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK
| | - P Chaote
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Teodorczuk
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Northumberland, Tyne and Wear NHS Trust, Newcastle Upon Tyne, UK
| | - R Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson's disease. Acta Neuropsychiatr 2015; 27:206-12. [PMID: 25777617 DOI: 10.1017/neu.2015.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability amongst the elderly in low-income countries. The aim of this study was to compare disability levels for three of the most common neurological, non-communicable diseases: dementia, stroke and Parkinson's disease (PD). METHODS We performed a community-based study of people aged 70 years and over in 12 randomly selected villages in the rural Hai district of Tanzania. Participants underwent disability assessment using the Barthel Index, and clinical assessment for dementia, stroke and PD. RESULTS In a representative cohort of 2232 people aged 70 years and over, there were 54 cases of stroke, 12 cases of PD and estimated (by extrapolation from a sub-sample of 1198 people) to be 112 cases of dementia. People with stroke were the most disabled, with 62.9% having moderate or severe disability. Levels of moderate or severe disability were 41.2% in people with dementia and 50.0% in people with PD. However, the higher prevalence of dementia meant that, at a population level, it was associated with similar levels of disability as stroke, with 18.5% of 249 people identified as having moderate or severe disability having dementia, compared to 13.7% for stroke and 2.4% for PD. CONCLUSIONS Levels of disability from these conditions is high and is likely to increase with demographic ageing. Innovative, community-based strategies to reduce disability levels should be investigated.
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