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Dückert S, Bart S, Gewohn P, König H, Schöttle D, Konnopka A, Rahlff P, Erik F, Vogeley K, Schulz H, David N, Peth J. Health-related quality of life in family caregivers of autistic adults. Front Psychiatry 2023; 14:1290407. [PMID: 38193135 PMCID: PMC10773769 DOI: 10.3389/fpsyt.2023.1290407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. Methods N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Results Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Discussion Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.
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Affiliation(s)
- Sophia Dückert
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bart
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Faculty Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Petia Gewohn
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pascal Rahlff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Erik
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Vogeley
- Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole David
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Burden and anticipatory grief in caregivers of family members with Alzheimer's disease and other dementias. Palliat Support Care 2023:1-11. [PMID: 37795789 DOI: 10.1017/s1478951523001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVES This study aimed to analyze the different factors that intervene in the task of caring for relatives of people with Alzheimer's and other dementias. A first objective focused on assessing the relation between burden and anticipatory grief, considering the possibility of social support and the risk of psychopathology. A second objective aimed to examine whether caregiver burden modulates the relationships between anticipatory grief and psychopathology. A cross-sectional design was employed. METHODS The sample consists of 129 participants who care for a family member with Alzheimer's and other dementias. A protocol based on a battery of tests has been applied and a mediation analysis was carried out. RESULTS The results show a positive relationship between burden and anticipatory grief. Social support could have an indirect relationship with anticipatory grief, based on its effect on the level of psychopathology and caregiver burden. Finally, a modulation model reflects that the relationship between anticipatory grief and psychopathology is strong, the latter having a greater effect as a result variable than as a risk variable. However, it seems that the relationship between grief and psychopathology is better explained directly than not through the modulating effect of the caregiver burden. SIGNIFICANCE OF RESULTS The results obtained encourage us to think that an approach focused on intervening in the anticipatory grief may be an opportunity to reduce or buffer other caregiving outcomes, especially those related to the perception of caregiver burden and psychopathology.
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Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, Barcelona, Spain
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Alves S, Paúl C, Ribeiro O. Transition to bereavement: A prospective longitudinal study of health-related quality of life in informal caregivers of oldest-old individuals. Front Med (Lausanne) 2022; 9:1031143. [PMID: 36530892 PMCID: PMC9748087 DOI: 10.3389/fmed.2022.1031143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/10/2022] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Experiencing bereavement may be challenging. Despite the oldest-old population increase, a subgroup at greater risk of death, few studies focus on the grieving process of informal caregivers (ICs). This study analyzed the transition to bereavement of ICs of oldest-old individuals (≥80 years) over 1-year and compares the evolution of the health-related quality of life (HrQoL) between those experiencing bereavement and those who continued care through the study period. MATERIALS AND METHODS A prospective longitudinal observational study was conducted enrolling 204 ICs of the Metropolitan Area of Porto (North Portugal), of which 36 experienced the death of care receiver (CR). ICs' health profile and burden were assessed. CRs' functional and cognitive status were also appraised. RESULTS Bereaving caregivers were mostly female, CRs' children, and had on average 60.4 years at baseline. Caregivers spent a mean of 10.1 h/day (SD = 7.7) caring, for 80.6 months (SD = 57.5). The time elapsed since CR's death was 6 months (SD = 3.5) from entering in the study. CRs who died had a mean age of 88.3 (SD = 5.4) years at baseline, and were very dependent. Over a 1-year follow-up, bereaving caregivers showed a significant decrease in mental health following CR's death; on the other hand, caregivers who continued caring improved mental health [F(1, 159) = 4.249, p = 0.041]. DISCUSSION Ending the caregiver career was marked by a decline in mental health whereas to continue caring was marked by an improvement in this outcome. While it is highly expected that the CR's death will be perceived as a relief considering both the caregiver's characteristics (e.g., medicines) and the CR condition (e.g., high dependence levels), the results suggest an opposite direction. CRs' death seems to arise an emotional burden for IC, at least during the first year, possibly triggering feelings of loneliness and a life without purpose that seems to aggravate mental health issues. CONCLUSION The transition to bereavement among ICs seems to lead to a caregiver mental health decline while those who continued caring (and thereby, experiencing caregiving stressors) seems to improve in this outcome. Ceasing caregiving stressors does not seem to contribute better experiencing bereavement among ICs, suggesting the need for support throughout this phase.
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Affiliation(s)
- Sara Alves
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS@RISE), ICBAS, Porto, Portugal
- Abel Salazar Institute of Biomedical Sciences – University of Porto (ICBAS-UP), Porto, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro, Aveiro, Portugal
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Makouei M, Hartup LA, Neuhoff BK, Boyd AR, Daftaribesheli L, Mirmoeeni S, Azari Jafari A, Godoy DA, Seifi A. The pathophysiologic, diagnostic, and therapeutic aspects of posterior reversible encephalopathy syndrome during pregnancy. J Matern Fetal Neonatal Med 2021; 35:8735-8743. [PMID: 34879767 DOI: 10.1080/14767058.2021.2001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with a wide range of symptoms, including visual disturbances, headache, vomiting, seizures, and altered consciousness. This review describes the pathophysiology of PRES, as well as the clinical, diagnostic, and therapeutic intervention during pregnancy. The gold standard for diagnosis of PRES is Magnetic Resonance Imaging (MRI), helping to differentiate it from other similar conditions. The aim of this paper is to review the principal aspects of PRES, general care, blood pressure control, and seizures prevention while avoiding potential injuries to the mother and fetus in the event of pregnancy. We concluded that PRES can be effectively treated and reversed if prompt diagnostic action is made, and adequate care is initiated.
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Affiliation(s)
- Mahsa Makouei
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Lindsay Anne Hartup
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Barbara Kate Neuhoff
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Angela Rodriguez Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Laleh Daftaribesheli
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Daniel Agustin Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Hospital Carlos Malbran, Catamarca, Argentina
| | - Ali Seifi
- Division of Neuro Critical Care, Department of Neurosurgery, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
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Vara-García C, Romero-Moreno R, Barrera-Caballero S, Pedroso-Chaparro MDS, Cabrera I, Márquez-González M, Olazarán J, Losada A. Personal values profiles in dementia family caregivers: their association with ambivalent feelings and anxious and depressive symptoms. Aging Ment Health 2021; 25:2160-2168. [PMID: 32954792 DOI: 10.1080/13607863.2020.1821169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Culture-related variables, such as personal values, have been suggested as important in stress processes, such as family caregiving of people with dementia. Personal values may be categorized into two dimensions: family and own personal values. Drawing upon the Sociocultural Stress and Coping model, the objective of this study is to analyze differences between caregivers depending on their values profiles. METHOD Participants were 333 family caregivers of a spouse or a parent with dementia. Caregivers chose their two most important values, apart from caregiving, from a list of eight family-related and non-family-related values (own values). Therefore, three values profiles were possible: Family-values profile (FVP: the two values are family related), Mixed-values profile (MVP: one family related value and one own value), and Own-values profile (OVP: two own values were selected). In addition to values, sociodemographic variables, commitment and satisfaction with caregiving value and with chosen values, ambivalent feelings, and anxiety and depression symptomatology were assessed. ANOVA analyses were conducted. RESULTS The analyses suggest that caregivers in the FVP had lower levels of anxiety and ambivalent feelings and a higher commitment to and satisfaction with their chosen values than the other profiles. No differences were found for commitment and satisfaction with the caregiving value. CONCLUSION Caregivers' value profiles seem to play an important role in the effects of stress over psychological health. Possible explanations of these effects about potential role conflicts and a higher commitment to values are discussed.
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Affiliation(s)
| | | | | | | | - Isabel Cabrera
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Department of Neurology, Hospital Gregorio Marañón, Madrid, Spain
| | - Andrés Losada
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Spain
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Sawyer C, Preston L, Taylor S, Davies M, Carter L, Krebs M, Cook N, Graham D, Thistlewaite F, Yorke J. Oncology patients' experiences in experimental medicine cancer trials: a qualitative study. BMJ Open 2021; 11:e047813. [PMID: 34610932 PMCID: PMC8493921 DOI: 10.1136/bmjopen-2020-047813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study aimed to explore patients' experiences of experimental cancer medicine (ECM) clinical trials. DESIGN The study's design was qualitative. Two focus groups with patients were undertaken followed by semistructured interviews, to explore patients' experiences of ECM clinical trials. Interviews and focus groups were audiorecorded and transcribed verbatim. Data were analysed using thematic analysis. SETTING A regional cancer centre (tertiary care) in North-West England. PARTICIPANTS Twelve patients (aged 52-79) participated in one of the two focus groups and 22 patients (aged 42-83) participated in interviews. PRIMARY OUTCOME MEASURE Patients' experiences of an ECM trial. RESULTS Four main themes were identified from the analysis: decision making, information needs, the experience of trial participation and impact of trial participation. Subthemes are presented in the manuscript. CONCLUSION To make fully informed decisions about trial participation, patients required the simplification of trial information and wanted more information about side effects, their response to trial treatment and the overall trial progress throughout the trial. Patients highlighted the need for improvement for the support provided to their family and friends.
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Affiliation(s)
- Chelsea Sawyer
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Laurie Preston
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Michelle Davies
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Louise Carter
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Matthew Krebs
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Natalie Cook
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Donna Graham
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Fiona Thistlewaite
- The Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work; School of Health Sciences, The University of Manchester, Manchester, UK
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Altamirano O, Weisman de Mamani A. Risk and Resiliency Factors Related to Dementia Caregiver Mental Health. FAMILY PROCESS 2021; 60:904-919. [PMID: 32619332 DOI: 10.1111/famp.12569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prevalence rates for dementia are expected to rise exponentially as the elderly population rises. With this comes a corresponding increase in the number of family members who will become dementia caregivers. Caregivers of people with dementia often experience a deterioration in mental health. Identifying factors that relate to caregiver mental health is necessary to develop appropriate interventions. The current study explored how family functioning (measured with a latent variable that includes family cohesion, family balance, and family communication), caregiver expressed emotion (EE), and patient symptom severity related to caregiver mental health (measured with a latent variable that includes depression, anxiety, and stress). Participants included 107 dementia caregivers. The following specific hypotheses were tested: lower levels of both (1) EE and (2) patient symptom severity, and (3) higher levels of family functioning would be related to better caregiver mental health. Results produced a well-fitting model: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Moreover, results indicated that better family functioning (Ɣ = -3.54, SE = 1.34, p = .008), lower levels of caregiver EE (β = .36, SE = 0.07, p < .01), and higher patient symptom severity (β = -3.03, SE = 0.88, p = .001) were related to better caregiver mental health. Results from this study suggest that efforts to bolster family functioning (i.e., enhance communication, promote cohesion, encourage flexibility) could help improve caregiver mental health.
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Affiliation(s)
- Olivia Altamirano
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Alzheimer's Disease Caregiver Characteristics and Their Relationship with Anticipatory Grief. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8838. [PMID: 34444587 PMCID: PMC8392352 DOI: 10.3390/ijerph18168838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
In Alzheimer's disease, two fundamental aspects become important for caregivers: ambiguity and ambivalence. Thus, anticipatory grief is considered an active psychological process that is very different from the mere anticipation of death. The present study aims to determine which characteristics of family caregivers of people with dementia, such as age, gender, educational level, relationship with the person with dementia, years with dementia or years as a caregiver, are related to the presence of anticipatory grief. A cross-sectional design was employed. The sample consisted of a total of 129 subjects who cared for a family member with dementia. A sociodemographic data sheet and a battery of tests measure the presence of anticipatory grief, caregiver burden and/or psychopathology. The results obtained allowed us to confirm some of the hypotheses regarding the anticipatory grief construct, the importance of the care time factor, in years and per day, as well as the relevance of the previous demographic and psychopathological profile (being female, spouse function and possible depressive symptomatology). Likewise, from the prediction analyzes performed, it seems that these variables can predict anticipatory grief. These results propose interesting opportunities to formulate care proposals to professionals and family caregivers in relation to care tasks and caregiver skills.
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Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), 08018 Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain;
- Institute of Neuroscience, University of Barcelona, 08035 Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, 08028 Barcelona, Spain
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Anderson JG, Flatt JD, Jabson Tree JM, Gross AL, Rose KM. Characteristics of Sexual and Gender Minority Caregivers of People With Dementia. J Aging Health 2021; 33:838-851. [PMID: 33998313 DOI: 10.1177/08982643211014767] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Given what little is known about the experiences of sexual and gender minority (SGM) caregivers of people with Alzheimer's disease and related dementias (ADRD), the aim of the current study was to describe psychosocial measures among these caregivers. Methods: We used an online survey and social media recruitment strategies. Results: Of 286 caregivers, the majority were gay men. Most respondents were white, with a third identifying as Latino American. The plurality of caregivers identified as a spouse/partner and were providing care for someone who identified as a sexual minority; one-fifth cared for someone transgender. Sexual orientation, perceived stress, caregiver stigma, and microaggressions were psychosocial factors associated with family quality of life and depressive symptoms in the caregivers. Discussion: This study is the first to provide a focused description of the characteristics and psychosocial needs of SGM caregivers of someone with ADRD, supporting development of targeted interventions for this population.
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Affiliation(s)
- Joel G Anderson
- College of Nursing, University of Tennessee-Knoxville, Knoxville TN, USA
| | - Jason D Flatt
- School of Public Health, 14722University of Nevada-Las Vegas, Las Vegas, NV, USA
| | | | - Alden L Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen M Rose
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, 2647The Ohio State University, Columbus, OH, USA
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Lin A, Vranceanu AM, Guanci M, Salgueiro D, Rosand J, Zale EL. Gender Differences in Longitudinal Associations Between Intimate Care, Resiliency, and Depression Among Informal Caregivers of Patients Surviving the Neuroscience Intensive Care Unit. Neurocrit Care 2021; 32:512-521. [PMID: 31270671 DOI: 10.1007/s12028-019-00772-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVE Informal caregivers (e.g., family and friends) are at risk for developing depression, which can be detrimental to both caregiver and patient functioning. Initial evidence suggests that resiliency may reduce the risk of depression. However, gender differences in associations between multiple psychosocial resiliency factors and depression have not been examined among neuroscience intensive care unit (neuro-ICU) caregivers. We explored interactions between caregiver gender and baseline resiliency factors on depression symptom severity at baseline through 3 and 6 months post-discharge. METHODS Caregivers (N = 96) of neuro-ICU patients able to provide informed consent to participate in research were enrolled as part of a prospective, longitudinal study in the neuro-ICU of a major academic medical center. Caregiver sociodemographics and resiliency factors (coping, mindfulness, self-efficacy, intimate care, and preparedness for caregiving) were assessed during the patient's hospitalization (i.e., baseline). Levels of depressive symptoms were measured using the Hospital Anxiety and Depression Scale at baseline, 3 months, and 6 months post-discharge. RESULTS Baseline depressive symptoms predicted depressive symptoms at both 3- and 6-month follow-ups, with no difference at any time point in rates of depression by gender. At baseline, greater levels of coping, mindfulness, and preparedness for caregiving were individually associated with lower levels of concurrent depression regardless of gender (ps < 0.006). The main effect of baseline coping remained significant at 3-month follow-up (p = 0.045). We observed a trend-level interaction between gender and baseline intimate care, such that among male caregivers only, high baseline intimate care was associated with lower depression at 3-month follow-up (p = 0.055). At 6-month follow-up, we observed a significant interaction between caregiver gender and baseline intimate care, such that male caregivers reporting high intimate care reported lower symptoms of depression than females reporting high intimate care (p = 0.037). CONCLUSIONS Results support implementation of psychosocial resiliency interventions for caregivers of patients admitted to the neuro-ICU early in the recovery process. Male caregivers may particularly benefit from strategies focused on increasing intimate care (e.g., physical and emotional affection with their loved one) and quality of the patient-caregiver dyadic relationship.
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Affiliation(s)
- Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, 02114, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, 02114, USA. .,Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Mary Guanci
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, USA
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Towle RM, Low LL, Tan SB, Hendrix C. Quality improvement study on early recognition and intervention of caregiver burden in a tertiary hospital. BMJ Open Qual 2020; 9:bmjoq-2019-000873. [PMID: 32753428 PMCID: PMC7406019 DOI: 10.1136/bmjoq-2019-000873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Caregivers play a crucial role in taking over the important task of looking after patients post-hospitalisation. Caregivers who are unfamiliar with patients’ post-discharge care often experience caregiver stress, while patients may see deterioration in their condition. As caregivers are our core partners in healthcare, it is therefore necessary for patient navigators to recognise, assess and address caregivers’ needs or burden as early as on admission to hospital. Patient navigators are trained registered nurses whose main role is to provide patients and caregivers with personalised guidance through the complex healthcare system. Objectives This quality improvement study examined the efficacy of using the Zarit Burden Interview as a tool in helping patient navigators recognise caregiver burden early and the effectiveness of targeted interventions on caregiver burden. Methods Various quality improvement tools were used. Eighty-six patient-caregiver dyads who met the inclusion criteria were enrolled. Informal caregivers were assessed for caregiver burden using the Zarit Burden Interview during hospital admission (T0) and again at 30 days postdischarge (T1), post-intervention. Results There was significant improvement in the Zarit Burden mean scores from T0 to T1 reported for the 80 dyads who completed the study, even after adjusting for covariates (T0 mean=11.08, SD=7.64; T1 mean=2.48, SD=3.36, positive ranks, p<0.001). Highest burden identified by most caregivers were the personal strain; trying to meet other responsibilities and uncertain about what to do in caring for their loved one. By recognising the different aspects of caregiver burden early, patient navigators were able to focus their interventions. Conclusion Early recognition of caregiver burden and targeted interventions were found to be effective at reducing caregiver burden in a tertiary hospital.
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Affiliation(s)
- Rachel Marie Towle
- Nursing, SingHealth Regional Health Service, Singapore General Hospital, Singapore
| | - Lian Leng Low
- SingHealth Regional Health Service; Family Medicine and Continuing Care, Singapore General Hospital, Singapore
| | | | - Cristina Hendrix
- Duke University School of Nursing; Durham Veterans Affairs GRECC, Durham, NC, USA
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Jiang N, Lu N, Sun Q, Lou VWQ. Positive and negative experiences and life satisfaction among spousal caregivers for frail older adults in urban China: a parallel process model. Age Ageing 2020; 49:622-627. [PMID: 32307544 DOI: 10.1093/ageing/afaa032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/11/2020] [Accepted: 02/04/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Previous literature has suggested that negative and positive aspects of spousal caregiving co-exist. However, positive and negative experiences were often examined independently. This study aimed to empirically test a parallel process model of spousal caregiving. METHODS This cross-sectional survey of family caregiving involved 269 frail older adults living in Shanghai, China, in 2016. Quota sampling was conducted to find community-dwelling frail older adults with a primary caregiver. Path analysis was used to identify the relationship between negative and positive caregiving experiences and life satisfaction. RESULTS We found two independent paths towards life satisfaction: (i) activities of daily living were negatively associated with burden, and burden was associated with lower life satisfaction; and (ii) spousal caregivers' self-reported health and financial state were positively associated with positive appraisal, and positive appraisal was associated with higher life satisfaction. Caregiving time contributed to both aspects of caregiving experiences. The covariance between caregiving burden and positive appraisals was not statistically significant. CONCLUSION Spousal caregiving involves a parallel process. Negative and positive experiences are separate constructs and their associations with life satisfaction vary. We advocate for policy and interventions that promote positive views of caregiving that encourage caregivers to develop a high level of overall life satisfaction despite the hardships of their caregiving tasks.
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Affiliation(s)
- Nan Jiang
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Nan Lu
- Department of Social Work, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Qian Sun
- Department of Social Security, School of Public Administration, Hebei University of Economics and Business, Shijiazhuang, China
| | - Vivian W Q Lou
- Department of Social Work & Social Administration, Sau Po Centre on Ageing, University of Hong Kong, Hong Kong
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13
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Hansen AC, Brown R, Keller P, Schoenberg N. Sources of Stress and Strength: Contextualizing the Experience of Grandparents Rearing Grandchildren in Appalachia. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2020. [DOI: 10.1080/15350770.2020.1774461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Robyn Brown
- University of Kentucky, Lexington, Kentucky, USA
| | - Peggy Keller
- University of Kentucky, Lexington, Kentucky, USA
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14
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Gallagher S, O'Sullivan L, Hughes Z, O'Connell BH. Building Resources in Caregivers: Feasibility of a Brief Writing Intervention to Increase Benefit Finding in Caregivers. Appl Psychol Health Well Being 2020; 12:513-531. [PMID: 32026574 PMCID: PMC7384052 DOI: 10.1111/aphw.12195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Building Resources in Caregivers (BRiC) is a pilot feasibility trial that compared the effects of a 2-week benefit finding writing expressive intervention to a control intervention, who wrote about the weather. Caregivers completed primary (benefit finding) and secondary (quality of life, depression and anxiety) outcome measures at pre (t1), immediately post-test (t2) and 1 month later (t3). They also completed measures relating to trial feasibility, difficulty, and acceptance. Using complete case analysis only, analysis revealed no effect of the intervention for primary or secondary outcomes. Despite this, there were no differences between the intervention and control groups on key feasibility measures. Caregivers in the control condition were less likely to recommend this to other caregivers. Moreover, qualitative commentary provided by caregivers suggested that not everyone enjoyed the writing, some found it stressful, offering up some explanation for our findings. Our pilot trial suggests that any future benefit-finding writing intervention would require several procedure modifications including tailoring to a specific cohort of caregivers, in particular those who like writing, before it has some utility as a psychosocial intervention.
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Affiliation(s)
- Stephen Gallagher
- University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Zoe Hughes
- Care Alliance Ireland, Dublin, Ireland.,University College Cork, Cork, Ireland
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15
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Changes in Caregiver Health in the Years Surrounding the Birth of a Child With Health Problems: Administrative Data From British Columbia. Med Care 2019; 57:369-376. [PMID: 30908379 DOI: 10.1097/mlr.0000000000001098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caregivers of children with health problems (CHPs; usually mothers) experience more physical and psychological health problems than those of children without health problems (non-CHPs). Primarily cross-sectional and survey-driven, this literature has not yet explored whether these health differences existed before the birth of the CHPs, or are exacerbated postbirth. METHODS Using linked administrative health data on all mother-child dyads for children born in the year 2000 in British Columbia, Canada, we examined maternal health before, during, and after the birth of CHPs, and compared it between mothers of CHPs and non-CHPs with piecewise growth curve modeling. RESULTS Compared with mothers of non-CHPs, mothers of CHPs had more physician visits (8.09 vs. 11.07), more medication types (1.81 vs. 2.60), and were more likely to be diagnosed with selected health conditions (30.9% vs. 42.5%) 4 years before the birth of the child. Over the 7-year postbirth period, the health of the 2 groups of mothers further diverged: while mothers of CHPs showed increases on physician visits and types of medication, mothers of non-CHPs did not experience any changes in physician visits and had less steep increases for types of medication. CONCLUSIONS Health issues associated with having a child with a health problem may begin well before the birth of the child, but also appear to be exacerbated postbirth. The health challenges of caregivers of CHPs may be multifactorial, involving both preexisting conditions and the stresses associated with caring for a child with health problems.
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16
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Ertl MM, Trapp SK, González Arredondo S, Rodríguez Agudelo Y, Arango-Lasprilla JC. Perceived stress, resilience, and health-related quality of life among Parkinson's disease caregivers in Mexico. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1303-1310. [PMID: 31149757 DOI: 10.1111/hsc.12767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
The stress process model of caregiving posits that caregivers' internal psychosocial resources may serve as buffers between the stress associated with caregiving and well-being. Empirical support for the stress process model exists for several caregiving contexts, but little research has investigated the Parkinson's disease caregiving experience in Mexico. Using a cross-sectional, correlational design, the objective of this study was to examine whether resilience moderates the relation between perceived stress and health-related quality of life (HRQOL) among Parkinson's disease caregivers in Mexico. Data were collected from April 2015 to February 2016 during outpatient neurology appointments in Mexico City, Mexico. Participants included informal caregivers (N = 95) for a family member with Parkinson's disease. Participants completed a battery of questionnaires assessing their level of perceived stress, resilience, and HRQOL. Regression analyses indicated that resilience moderated the inverse relation between perceived stress and mental HRQOL. However, contrary to hypotheses, resilience did not moderate the relation between stress and physical HRQOL. Findings shed light on resilience as a potential protective factor for mental HRQOL among Parkinson's disease caregivers in Mexico and indicate that resilience may be beneficial to target in mental health promotion interventions.
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Affiliation(s)
- Melissa M Ertl
- Division of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York
| | - Stephen K Trapp
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Susana González Arredondo
- Department of Neuropsychology, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
| | - Yaneth Rodríguez Agudelo
- Department of Neuropsychology, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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17
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Del-Pino-Casado R, Serrano-Ortega N, López-Martínez C, Orgeta V. Coping strategies and psychological distress in family carers of frail older people: A longitudinal study. J Affect Disord 2019; 256:517-523. [PMID: 31280075 DOI: 10.1016/j.jad.2019.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/03/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Carers of dependent older people experience high levels of psychological distress. However, little is known about the effects of coping on carer distress over time. In this one year longitudinal study we investigated the relationship between distress, and coping strategies in a representative sample of family carers living in Spain. METHODS Primary carers of older people were recruited (N = 200). We used probability sampling and collected data via individual interviews from 2013 to 2015. Variables investigated included psychological distress, coping, and levels of objective and subjective burden. Panel data analysis was used to test a model of association of psychological distress, and coping strategies controlling for key confounders. RESULTS Acceptance and emotional support were the most frequently used strategies, whereas behavioural disengagement and humour were the least used. In the panel data regressions, positive reframing (B = -0.79, p < 0.001), self-distraction (B = -0.46, p = 0.034), substance use (B = 0.57, p < 0.001) and denial (B = 0.57, p = 0,049) were significantly related to psychological distress at one year follow-up. LIMITATIONS Limitations include participant drop out and assessing substance use coping via a brief measure. CONCLUSIONS Positive reframing and self-distraction were longitudinally associated with lower levels of carer psychological distress. Using denial and substance use coping increased distress long-term. Our results suggest that interventions that focus on positive reframing and assisting carers in decreasing dysfunctional coping may be useful therapeutic targets mitigating carer psychological morbidity.
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18
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Towle RM, Tan CG, Saptu K, Ong LJ, Yap MM, Kheng JH, Low LL. What do caregivers value and is there agreement in perception of met needs between nurses and caregivers? Singapore Med J 2019; 60:575-582. [PMID: 31044258 DOI: 10.11622/smedj.2019040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is an increasing reliance on informal caregivers to continue the care of patients after discharge. This is a huge responsibility for caregivers and some may feel unprepared for the role. Without adequate support and understanding regarding their needs, patient care may be impeded. This study aimed to identify the needs valued by caregivers and if there was agreement between acute care nurses and caregivers in the perception of whether caregiver needs were being met. METHODS We conducted face-to-face interviews with 100 pairs of acute care nurses and caregivers. Participants were recruited from inpatient wards through convenience sampling. Questionnaires included demographic data of nurses and caregivers, patients' activities of daily living, and perception of caregiver needs being met in six domains of care. Independent t-test was used to compare mean values in each domain, and intraclass correlation coefficient was used to compare agreement in perception. RESULTS Caregivers valued reassurance the most. Three domains of care needs showed significant differences in perception of caregiver needs being met:reassurance (p = 0.002), honesty and timeliness (p = 0.008), and kindness and genuine care (p = 0.026). There was poor agreement in all six domains of caregiver needs being met between nurses and caregivers. CONCLUSION Although caregivers valued reassurance the most, there was poor agreement between acute care nurses and caregivers in the perception of caregiver needs being met. Hence, more attention should be paid to the caregiver's needs. Further studies can examine reasons for unmet caregiver needs and interventions to improve support for them.
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Affiliation(s)
- Rachel Marie Towle
- Nursing Division, Speciality Nursing, Singapore General Hospital, Singapore
| | - Cheng Gaik Tan
- Office of Integrated Care, Singapore General Hospital, Singapore
| | - Kalsom Saptu
- Office of Integrated Care, Singapore General Hospital, Singapore
| | - Li Jiao Ong
- Office of Integrated Care, Singapore General Hospital, Singapore
| | - Mei Mei Yap
- Office of Integrated Care, Singapore General Hospital, Singapore
| | - Jia Hui Kheng
- Office of Integrated Care, Singapore General Hospital, Singapore
| | - Lian Leng Low
- Family Medicine and Continuing Care, Singapore General Hospital, Singapore
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19
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Morimoto H, Furuta N, Kono M, Kabeya M. Stress-buffering Effect of Coping Strategies on Interrole Conflict among Family Caregivers of People with Dementia. Clin Gerontol 2019; 42:34-46. [PMID: 28990875 DOI: 10.1080/07317115.2017.1368764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine the stress-buffering effect of coping strategies on the adverse effects of interrole conflict on the mental health of employed family caregivers, and clarify the moderating role of attentional control on this stress-buffering effect. METHODS Data were drawn from a two-wave longitudinal online survey of employed Japanese family caregivers of people with dementia (263 males, 116 females; age 51.54 ± 9.07 years). We assessed interrole conflict, coping strategies, attentional control, mental health variables (psychological strain and quality of life), and confounding factors. RESULTS Hierarchical regression analyses controlled for sociodemographic factors found formal support seeking had a stress-buffering effect for strain- and behavior-based caregiving interfering with work (CIW) only on psychological strain, and was moderated by attentional control. Single slope analysis showed higher CIW was related to higher psychological strain in those with greater use of formal support seeking and lower attentional control, but not in those with higher attentional control. CONCLUSIONS Greater use of formal support seeking weakens the adverse effects of strain- and behavior-based CIW on psychological strain in people with high attentional control. CLINICAL IMPLICATIONS Attentional control is a key factor in the stress-buffering effect of formal support seeking on strain- and behavior-based CIW.
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Affiliation(s)
- Hiroshi Morimoto
- a Faculty of Psychology , Hiroshima International University , Hiroshima , Japan
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20
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Betini RSD, Hirdes JP, Curtin-Telegdi N, Gammage L, Vansickle J, Poss J, Heckman G. Development and validation of a screener based on interRAI assessments to measure informal caregiver wellbeing in the community. BMC Geriatr 2018; 18:310. [PMID: 30545318 PMCID: PMC6293658 DOI: 10.1186/s12877-018-0986-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/20/2018] [Indexed: 12/04/2022] Open
Abstract
Background Informal caregivers are invaluable partners of the health care system. However, their caring responsibilities often affect their psychological wellbeing and ability to continue in their role. It is of paramount importance to easily identify caregivers that would benefit from immediate assistance. Methods In this nonexperimental cohort study, a cross-sectional analysis was conducted among 362 informal caregivers (mean age 64.1 years, SD ± 13.1) caring for persons with high care needs (mean age 78.6 years, SD ± 15.0). Caregivers were interviewed using an interRAI-based self-reported survey with 82 items covering characteristics of caregivers including key aspects of wellbeing. A factor analysis identified items in the caregiver survey dealing with subjective wellbeing that were compared against other wellbeing measures. A screener, called Caregiver Wellbeing Index (CWBI), consisting of four items with response scores ranging from 0 to 2 was created. The CWBI was validated in a follow-up study in which 1020 screeners were completed by informal caregivers of home care clients. Clinical assessments of the care recipients (n = 262) and information on long-term care home (LTCH) admission (n = 176) were linked to the screener dataset. The association between the CWBI scores and caregiver and care recipient characteristics were assessed using logistic regression models and chi-square tests. The reliability of CWBI was also measured. Results The CWBI scores ranging from zero to eight were split in four ‘wellbeing’ levels (excellent, good, fair, poor). In the validation study, fair/poor psychological wellbeing was strongly associated with caregiver reports of inability to continue in their role; conflict with family; or feelings of distress, anger, or depression (P < 0.0001). Caregivers caring for a care recipient that presented changes in behavior, cognition, and mood were more likely to present fair/poor wellbeing (P < 0.0001). Additionally, caregivers with high CWBI scores (poor wellbeing) were also more likely to provide care for someone who was admitted to a LTCH (OR 3.52, CI 1.32–9.34) after controlling for care recipient and caregiver characteristics. The Cronbach alpha value 0.89 indicated high reliability. Conclusion The CWBI is a valid screener that can easily identify caregivers that might benefit from further assessment and interventions.
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Affiliation(s)
- Raquel S D Betini
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - John P Hirdes
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Nancy Curtin-Telegdi
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Gammage
- Nucleus Independent Living, Oakville, ON, L6H 6P5, Canada
| | - Jennifer Vansickle
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Hamilton, ON, L8J 0G5, Canada
| | - Jeff Poss
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - George Heckman
- University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.,Schlegel Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Monteiro AMF, Santos RL, Kimura N, Baptista MAT, Dourado MCN. Coping strategies among caregivers of people with Alzheimer disease: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:258-268. [DOI: 10.1590/2237-6089-2017-0065] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
Abstract Introduction Caregivers of people with Alzheimer disease (PwAD) report significant stress, burden and depression compared to caregivers of people with other dementias, especially when neuropsychiatric symptoms are prominent. Adequate coping strategies can modify the impact of stressful situations and increase the caregivers’ quality of life. Objective To systematically review the different coping strategies used by caregivers of PwAD to manage neuropsychiatric symptoms. Method We carried out electronic searches using MEDLINE (PubMed), SciELO, Web of Knowledge Cross Search (Thomson Scientific/ISI Web Services) and PsycINFO databases to select studies on coping in PwAD caregivers published from January 2005 to July 2017. The search terms were coping, caregivers, strategy, onset, adaptation, family, behavior, dementia and Alzheimer. The studies were organized in three categories: problem-focused, emotion-focused and dysfunctional coping strategies. Results We found 2,277 articles. After application of exclusion criteria and exclusion of redundant references, 24 articles were analyzed. Emotion-focused coping was the most commonly used strategy among PwAD caregivers. The use of this strategy associated with religion and spirituality may help reduce symptoms of depression and anxiety. Problem-focused coping strategies were mostly used with active coping interventions. Problem-solving coping may have buffered the impact of acute psychological stressors on procoagulant activity. Dysfunctional coping strategies were associated with increase of caregiver burden. Conclusion The evaluated studies showed that the use and development of coping strategies may have ameliorated the depressive symptoms, anxiety and burden of caregivers. However, longitudinal studies are still needed that clearly describe the type of coping strategy used in relation to the presented results.
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22
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Wu MS, Hamblin R, Nadeau J, Simmons J, Smith A, Wilson M, Eken S, Small B, Phares V, Storch EA. Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment. Compr Psychiatry 2018; 80:46-56. [PMID: 29031217 PMCID: PMC5858930 DOI: 10.1016/j.comppsych.2017.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program. METHOD The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires. RESULTS Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL. CONCLUSION Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.
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Affiliation(s)
- Monica S Wu
- Department of Psychology, University of South Florida, Tampa, FL, USA; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | | | - Joshua Nadeau
- Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Ashley Smith
- Rogers Behavioral Health - Nashville, Nashville, TN, USA
| | | | - Stephanie Eken
- Rogers Behavioral Health - Nashville, Nashville, TN, USA
| | - Brent Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Vicky Phares
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Health Management and Policy, University of South Florida, Tampa, FL, USA; Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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23
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Goodwin SW, Wilk P, Karen Campbell M, Speechley KN. Emotional well-being in children with epilepsy: Family factors as mediators and moderators. Epilepsia 2017; 58:1912-1919. [DOI: 10.1111/epi.13900] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Shane W. Goodwin
- Department of Epidemiology & Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
| | - Piotr Wilk
- Department of Epidemiology & Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
- Department of Paediatrics; Western University; London Ontario Canada
| | - M. Karen Campbell
- Department of Epidemiology & Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
- Department of Paediatrics; Western University; London Ontario Canada
- Department of Obstetrics and Gynecology; Western University; London Ontario Canada
| | - Kathy N. Speechley
- Department of Epidemiology & Biostatistics; Western University; London Ontario Canada
- Children's Health Research Institute; Lawson Health Research Institute; London Ontario Canada
- Department of Paediatrics; Western University; London Ontario Canada
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24
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Bouldin ED, Shaull L, Andresen EM, Edwards VJ, McGuire LC. Financial and Health Barriers and Caregiving-Related Difficulties Among Rural and Urban Caregivers. J Rural Health 2017; 34:263-274. [PMID: 28940539 DOI: 10.1111/jrh.12273] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess whether financial or health-related barriers were more common among rural caregivers and whether rural caregivers experienced more caregiving-related difficulties than their urban peers. METHODS We used data from 7,436 respondents to the Caregiver Module in 10 states from the 2011-2013 Behavioral Risk Factor Surveillance System. Respondents were classified as caregivers if they reported providing care to a family member or friend because of a long-term illness or disability. We classified respondents as living in a rural area if they lived outside of a Metropolitan Statistical Area (MSA). We defined a financial barrier as having an annual household income <$25,000 or not being able see a doctor when needed in the past year because of cost. We defined a health barrier as having multiple chronic health conditions, a disability, or fair or poor self-rated health. FINDINGS Rural caregivers more frequently had financial barriers than urban caregivers (38.1% vs 31.0%, P = .0001), but the prevalence of health barriers was similar (43.3% vs 40.6%, P = .18). After adjusting for demographic differences, financial barriers remained more common among rural caregivers. Rural caregivers were less likely than their urban peers to report that caregiving created any difficulty in both unadjusted and adjusted models (adjusted prevalence ratio = 0.90; P < .001). CONCLUSIONS Informal caregivers, particularly in rural areas, face financial barriers. Rural caregivers were less likely than urban caregivers to report caregiving-related difficulties. Rural caregivers' coping strategies or skills in identifying informal supports may explain this difference, but additional research is needed to explore this hypothesis.
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Affiliation(s)
- Erin D Bouldin
- Department of Health and Exercise Science, Appalachian State University, Boone, North Carolina
| | - Lynn Shaull
- Association of State and Territorial Health Officials, Washington, DC
| | - Elena M Andresen
- Institute on Development and Disability, School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Valerie J Edwards
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C McGuire
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Internal resources among informal caregivers: trajectories and associations with well-being. Qual Life Res 2017; 26:3239-3250. [PMID: 28730302 DOI: 10.1007/s11136-017-1647-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE The experiences, skills, and internal resources that informal caregivers bring into their role may play a critical part in their mental health and well-being. This study examined how caregiver internal resources changed over a 10 year period, and how this was related to caregivers' well-being. METHODS Data are from the Midlife in the United States (MIDUS) study, a national sample of adults, at two time points: 1995-1996 (T1) and 2004-2006 (T2). We identified subjects who reported being a caregiver at T2 and starting care after T1 (mean age = 56; 65% female). We examined internal resources: sense of control (personal mastery); primary and secondary control strategies (persistence in goal striving, positive reappraisal, and lowering expectations); and social support seeking, and psychological and subjective well-being. We evaluated how internal resources changed over time, and how these trajectories were associated with well-being at T2 using multivariable linear regressions. RESULTS Most caregivers had stable levels of internal resources (between 4 and 13% showed an increase or decrease). Caregivers with increasing or high-stable levels of personal mastery had significantly better well-being scores on 6 out of 8 subscales compared with low-stable levels [effect sizes (ES) between 0.39 and 0.79]. Increasing persistence was associated with better personal growth and environmental mastery (ES = 0.96 and 0.91), and increasing and high-stable positive reappraisals were associated with better affect (ES = 0.63 and 0.48) compared with low-stable levels. Lowering aspirations and support seeking were not associated with well-being outcomes. CONCLUSIONS Practices or interventions that support or improve internal resources could potentially improve caregiver well-being.
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Tuarob S, Tucker CS, Kumara S, Giles CL, Pincus AL, Conroy DE, Ram N. How are you feeling?: A personalized methodology for predicting mental states from temporally observable physical and behavioral information. J Biomed Inform 2017; 68:1-19. [PMID: 28213145 PMCID: PMC5453908 DOI: 10.1016/j.jbi.2017.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/12/2017] [Accepted: 02/13/2017] [Indexed: 01/07/2023]
Abstract
It is believed that anomalous mental states such as stress and anxiety not only cause suffering for the individuals, but also lead to tragedies in some extreme cases. The ability to predict the mental state of an individual at both current and future time periods could prove critical to healthcare practitioners. Currently, the practical way to predict an individual's mental state is through mental examinations that involve psychological experts performing the evaluations. However, such methods can be time and resource consuming, mitigating their broad applicability to a wide population. Furthermore, some individuals may also be unaware of their mental states or may feel uncomfortable to express themselves during the evaluations. Hence, their anomalous mental states could remain undetected for a prolonged period of time. The objective of this work is to demonstrate the ability of using advanced machine learning based approaches to generate mathematical models that predict current and future mental states of an individual. The problem of mental state prediction is transformed into the time series forecasting problem, where an individual is represented as a multivariate time series stream of monitored physical and behavioral attributes. A personalized mathematical model is then automatically generated to capture the dependencies among these attributes, which is used for prediction of mental states for each individual. In particular, we first illustrate the drawbacks of traditional multivariate time series forecasting methodologies such as vector autoregression. Then, we show that such issues could be mitigated by using machine learning regression techniques which are modified for capturing temporal dependencies in time series data. A case study using the data from 150 human participants illustrates that the proposed machine learning based forecasting methods are more suitable for high-dimensional psychological data than the traditional vector autoregressive model in terms of both magnitude of error and directional accuracy. These results not only present a successful usage of machine learning techniques in psychological studies, but also serve as a building block for multiple medical applications that could rely on an automated system to gauge individuals' mental states.
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Affiliation(s)
- Suppawong Tuarob
- Faculty of Information and Communication Technology, Mahidol University, Thailand.
| | - Conrad S Tucker
- Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Soundar Kumara
- Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - C Lee Giles
- Information Sciences and Technology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Aaron L Pincus
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA
| | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Nilam Ram
- Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA
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Romley JA, Shah AK, Chung PJ, Elliott MN, Vestal KD, Schuster MA. Family-Provided Health Care for Children With Special Health Care Needs. Pediatrics 2017; 139:peds.2016-1287. [PMID: 28028202 DOI: 10.1542/peds.2016-1287] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many children with special health care needs (CSHCN) receive health care at home from family members, but the extent of this care is poorly quantified. This study's goals were to create a profile of CSHCN who receive family-provided health care and to quantify the extent of such care. METHODS We analyzed data from the 2009-2010 National Survey of Children with Special Health Care Needs, a nationally representative sample of 40 242 parents/guardians of CSHCN. Outcomes included sociodemographic characteristics of CSHCN and their households, time spent by family members providing health care at home to CSHCN, and the total economic cost of such care. Caregiving hours were assessed at (1) the cost of hiring an alternative caregiver (the "replacement cost" approach), and (2) caregiver wages (the "foregone earnings" approach). RESULTS Approximately 5.6 million US CSHCN received 1.5 billion hours annually of family-provided health care. Replacement with a home health aide would have cost an estimated $35.7 billion or $6400 per child per year in 2015 dollars ($11.6 billion or $2100 per child per year at minimum wage). The associated foregone earnings were $17.6 billion or $3200 per child per year. CSHCN most likely to receive the greatest amount of family-provided health care at home were ages 0 to 5 years, were Hispanic, lived below the federal poverty level, had no parents/guardians who had finished high school, had both public and private insurance, and had severe conditions/problems. CONCLUSIONS US families provide a significant quantity of health care at home to CSHCN, representing a substantial economic cost.
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Affiliation(s)
- John A Romley
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California.,RAND Corporation, Santa Monica, California
| | - Aakash K Shah
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Paul J Chung
- RAND Corporation, Santa Monica, California.,Departments of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine, and.,Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | | | - Katherine D Vestal
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Karlin NJ, Bell PA, Noah JL, Martichuski DK, Knight BL. Assessing Alzheimer's support group particpation: A retrospective follow-up. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759901400607] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Conflicting findings have been reported on whether attending an Alzheimer's disease (AD) support group is a positive or negative experience. As a result, the present study provides the results from a retrospective analysis of the effects of caregiver support groups over an eight year period. The results suggest that those in distress are the most likely to attend support groups, and the benefits of attending become more apparent over time. The primary reason given by participants for having stopped attending support groups was the lack of a program for those who no longer are active care providers. Many of these same individuals indicated a marked interest in caregiver issues, but felt that most of the information provided was for those providers early in the care process. Thus, support groups that consider caregiver transitions may prove of interest.
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Affiliation(s)
- Nancy J. Karlin
- University of Northern Colorado, Department of Psychology, Greeley, Colorado
| | - Paul A. Bell
- Colorado State University, Department of Psychology, Fort Collins, Colorado
| | - Jody L. Noah
- University of Northern Colorado, Department of Psychology, Greeley, Colorado
| | | | - Barbara L. Knight
- Colorado State University, Department of Psychology, Fort Collins, Colorado
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Abstract
This longitudinal study of 121 caregivers of the elderly evaluates the change in their self-assessed mental and physical health over two years. The care recipients, who were drawn from a random sample of noninstitutionalized urban elders, showed increased need for help with personal and instrumental activities of daily living in this period. Both the physical and mental health of the caregivers declined significantly during the study. Predictors of decline in physical health of the caregivers at the end of the study were poorer physical health at the start, the amount of help they provided, a decline in their own mental health, and an increase in the number of other persons also available to provide care. In contrast, decline in caregivers’ mental health at the end was predicted only by poorer mental health at the start and by decline in physical health.
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Ducharme F, Lévesque L, Lachance L, Gangbè M, Zarit SH, Vézina J, Caron CD. Older Husbands as Caregivers. Res Aging 2016. [DOI: 10.1177/0164027506291749] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study, based on Pearlin et al.'s model, was to determine the factors associated with the health of older husband caregivers and with their intention to end home caregiving for their wives. The results showed subjective stressors to be associated with outcomes. Role overload was linked to psychological distress and to lower self-perceived health, whereas role captivity was associated with psychological distress and the intention to end home caregiving. The likelihood of ceasing home caregiving increased when caregivers reported high relational deprivation. A high percentage of the variance in psychological distress was explained (51%). The quality of prior husband-wife relationships, the frequency of disruptive behaviors, family conflicts, and self-efficacy were associated with this variable. Selfefficacy had a mediating effect between subjective stressors and psychological distress, whereas the number of services received had a moderating effect on the intention to end home caregiving among husbands with high role captivity. This study provides avenues for interventions sensitive to male caregivers.
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Abstract
This study examined whether support from care recipients' primary care providers affects the stress and health of caregivers. This two-year longitudinal study addressed changes in caregivers' mental and physical health, both self-assessed and evaluated by professional nurse practitioners in physical examinations, and the effects of provider support on caregivers' health. Randomly selected participants from three previous studies plus a group of volunteer Alzheimer's caregivers constituted the sample. Of 254 eligible individuals, 150 agreed to participate, but by time 2, care recipient deaths and other reasons had reduced the number of caregivers to 99. Participants showed significant increases in stress and service use but declines in all areas of health and in provider support. Provider support did not materially affect caregivers' health but had an indirect effect on caregivers' self-assessed health through rewards. Despite the need for bolstering caregivers' health, perceived support from care recipients' providers is limited.
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Abstract
This study tested a social support enhancement intervention for caregivers to relatives with Alzheimer’s disease. Theory and empirical research on life-course transitions and social support suggest that support from an experientially similar peer (i.e., a person who has undergone the same stressful transition) will lead to positive outcomes among caregivers. The intervention differed from previous programs for caregivers by isolating social support enhancement as the intervention mechanism, without simultaneously providing education, counseling, or direct services. Using a randomized, control-group design, no main effects were found. At the level of interactions, a modest buffering effect was found for persons in more stressful caregiving situations. However, the overall pattern of the results suggests that social support alone is not a sufficient intervention to improve the experience of caregivers. Implications for future research and planning of interventions are discussed.
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Thai JN, Barnhart CE, Cagle J, Smith AK. "It Just Consumes Your Life": Quality of Life for Informal Caregivers of Diverse Older Adults With Late-Life Disability. Am J Hosp Palliat Care 2016; 33:644-50. [PMID: 25948041 PMCID: PMC4636480 DOI: 10.1177/1049909115583044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the quality of life (QoL) for informal caregivers of disabled older adults aged 65+ with diverse backgrounds. Forty-two caregivers were interviewed in English and Cantonese about their caregiving experiences, their recollections of QoL over time, and the factors influencing their appraisals. Overall, 52% of caregivers experienced a decline in QoL. Factors associated with decreased QoL were less time for self, competing financial demands, and the physical and emotional impact of the patient's illness. Factors associated with no change in QoL were minimal caregiving responsibilities, a sense of filial duty, and QoL being consistently poor over time. Factors associated with improved QoL were perceived rewards in caregiving, receiving institutional help, and increased experience. Chinese caregivers were more likely to cite filial duty as their motivator for continued caregiving than were Caucasian caregivers. In conclusion, informal caregivers take on a huge burden in enabling older adults to age in the community. These caregivers need more support in maintaining their QoL.
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Affiliation(s)
- Julie N Thai
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA
| | - Caroline E Barnhart
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA, USA
| | - John Cagle
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA Geriatrics, Palliative, and Extended Care, San Francisco VA Medical Center, San Francisco, CA, USA
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Huang CY, Musil CM, Zauszniewski JA, Wykle ML. Effects of Social Support and Coping of Family Caregivers of Older Adults with Dementia in Taiwan. Int J Aging Hum Dev 2016; 63:1-25. [PMID: 16986648 DOI: 10.2190/72ju-abqa-6l6f-g98q] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkman's (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearson's correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers.
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Ducharme F, Lévesque L, Zarit SH, Lachance L, Giroux F. Changes in Health Outcomes among Older Husband Caregivers: A One-Year Longitudinal Study. Int J Aging Hum Dev 2016; 65:73-96. [PMID: 17703750 DOI: 10.2190/9754-21rh-5148-8025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This one-year longitudinal study carried out on a sample of 232 older husband caregivers sought to describe changes in psychological distress and self-perceived health, and to examine relationships between factors drawn primarily from Pearlin's model of caregiving and changes in these two health outcomes. Prediction analyses shows that nearly two thirds of the husbands have unsuccessful outcomes with respect to these two dimensions, that is, most husbands obtain either steadily poor scores at both times of the study or worse scores on one or both outcomes. Higher levels of education and informal instrumental support at time 1, as well as an increase in role overload, are predictive of unsuccessful outcome for psychological distress, whereas an increase in self-efficacy predicts successful outcome for self-perceived health. Overall, husband caregivers vary in their response to caregiving over time. The findings support previous study results showing subjective stressors, rather than objective stressors, and caregiver resources to be significant predictors of caregiving outcomes.
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Affiliation(s)
- Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal and Centre de recherche, Institut universitaire de gériatrie de Montréal, Québec, Canada.
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Wang M, He B, Wang Y, Wu F, Chen X, Wang W, Yang X. Depression among Low-Income Female Muslim Uyghur and Kazakh Informal Caregivers of Disabled Elders in Far Western China: Influence on the Caregivers' Burden and the Disabled Elders' Quality of Life. PLoS One 2016; 11:e0156382. [PMID: 27244459 PMCID: PMC4887108 DOI: 10.1371/journal.pone.0156382] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/15/2016] [Indexed: 01/08/2023] Open
Abstract
Background Paying attention to and improving the mental health of the informal caregivers of disabled elders has become a global public health priority. This study focused on low-income female Uyghur and Kazakh informal caregivers of disabled elders residing in China’s far west. It investigated the prevalence of and the major related factors of depressive emotion. Methods A cross-sectional study was performed from September 2013 to January 2014 in Shawan Prefectures, Tuokexun Prefectures, Bole Prefecture and Urumchi city. Shawan Prefecture has the highest proportion of Kazakhs, whereas Tuokexun Prefectures, Bole Prefecture and Urumchi city have the highest proportion of Uyghurs in Muslim ethnic Uygur and Kazakh communities. Xinjiang Uyghur Autonomous Region is located in remote western China; this area is approximately 3,105 km (1,929 miles) away from Beijing. A total of 444 female Uyghur and Kazakh informal caregivers of disabled elders participated in this study. The self-rating depression scale, the Zarit burden interview, and the SF-36 questionnaire were used to evaluate the state of caregiver depression, caregiver burden, and quality of life (QOL), respectively. Statistical analyses were performed using multivariate logistic regression analyses, correlation with Spearman’s rho and independent-sample t-tests; a P-value of <0.05 was considered statistically significant. Results Up to 38.5% (n = 217) of informal caregivers reported having depression, whereas 61.5% (n = 273) of them reported a lack of depression. Age of disabled elders more than 60 years old, total hours spent on caring daily≥8h, duration of caring≥5 years, negative self-evaluation of health condition, having caregiver burden, elders’ medium degree of disability and elders’ heavy degree of disability had a higher risk of caregiver depression. By contrast, daughter/daughter-in-law of disabled elders; unemployed carers, family’s per capita income >US$235.48(1500 yuan), high social support, and high QOL of disabled elders were each associated with a lower risk of depressive emotion. Moreover, informal caregivers with depression obtained high care burden scores; at the same time, disabled elders who were looked after by caregivers with depression obtained low QOL scores. Conclusions Our findings suggest that the demographics characteristics of informal caregivers, and caregiver burden, and the disabled elders’ degree of disability and QOL had the most significant correlation with depressive emotion among women informal caregivers. The results had a enlighten that these variables should be considered while planning interventions to improve depression of informal caregivers.
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Affiliation(s)
- Meiyan Wang
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Bin He
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yuhuan Wang
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
- * E-mail:
| | - Fuchen Wu
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xuefeng Chen
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wenting Wang
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xue Yang
- Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Nogales-González C, Romero-Moreno R, Losada A, Márquez-González M, Zarit SH. Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers. Aging Ment Health 2015; 19:1022-30. [PMID: 25559886 DOI: 10.1080/13607863.2014.995593] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Behavioral and psychological symptoms in dementia (BPSD) are the principal sources of stress in caregivers. The aim of the present work is to analyze the moderating effect of self-efficacy for managing BPSD on the distress these problems generate in family caregivers. METHOD The participants were 231 family caregivers of people with dementia. We assessed the frequency and caregiver distress associated with three dimensions of BPSD (depressive, disruptive and memory problems). In addition, we assessed the moderating effect of self-efficacy for dealing with BPSD in the relationship between the dementia patient's frequency of BPSD and caregiver distress through hierarchical regression analyses, one for each of the dimensions of BPSD. RESULTS We found a moderating effect of self-efficacy on the relation between the frequency of BPSD and the distress in caregivers for the dimensions of depressive and disruptive behaviors. Caregivers having to deal with a high frequency of behavior problems but with high levels of self-efficacy presented significantly lower levels of distress associated with depressive and disruptive behavior problems compared to those caregivers with low levels of self-efficacy. No differences in the effects of self-efficacy were found for distress levels of caregivers who dealt with low frequency of BPSD. Also, we did not find a moderating effect of self-efficacy on the relation between the frequency of memory problems and caregivers' distress. CONCLUSIONS The results suggest that self-efficacy for managing BPSD attenuates the relation between the frequency of behavior problems – both disruptive and depressive – and the distress they cause in caregivers.
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Affiliation(s)
- C Nogales-González
- a Department of Psychology , Universidad Rey Juan Carlos de Madrid , Madrid , Spain
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de Oliveira GR, Neto JF, de Camargo SM, Lucchetti ALG, Espinha DCM, Lucchetti G. Caregiving across the lifespan: comparing caregiver burden, mental health, and quality of life. Psychogeriatrics 2015; 15:123-132. [PMID: 25521215 DOI: 10.1111/psyg.12087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/02/2014] [Accepted: 09/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Care can be considered a lifelong process, but caring for a child is different from caring for an older adult. The present study aims to compare the caregiving process from infancy through old age by evaluating differences in caregiver burden, mental health, and quality of life and to describe the factors that could impact these outcomes. METHODS To compare different groups of caregivers, we included 300 caregivers recruited from admissions to a tertiary acute hospital: 100 caregivers of children, 100 caregivers of adults, and 100 caregivers of older adults. A self-administered questionnaire was used that covered the following: sociodemographics, depression (Beck Depression Inventory), anxiety (Beck Anxiety Inventory), quality of life (Short Form Health Survey (SF-36)), religiosity (Duke Religion Index) and caregiver burden (Zarit Caregiver Burden Interview). RESULTS A comparison between groups was performed (through χ2 and anova), and a linear regression analysis was used to assess the related factors. We found that children's caregivers had more depressive symptoms (higher Beck Depression Inventory scores), better physical health (SF-36: physical functioning and SF-36: Physical Component Summary), and lower pain (SF-36: bodily pain) than other caregivers. We found that caregivers of adults had better mental health (SF-36: mental health and SF-36: Mental Component Summary) than other caregivers and that caregivers of older adult had a higher caregiver burden (Zarit Caregiver Burden Interview scores) than other caregivers. After we controlled for baseline characteristics, only depressive symptoms and caregiver burden remained statistically significant. CONCLUSION In conclusion, there are important differences between caregiving across the lifespan. Caregiving for children was associated with more depressive symptoms, and caregiving for older adults was associated with higher caregiver burden. Further studies are needed to replicate these findings in other settings.
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Haines KJ, Denehy L, Skinner EH, Warrillow S, Berney S. Psychosocial Outcomes in Informal Caregivers of the Critically Ill. Crit Care Med 2015; 43:1112-20. [DOI: 10.1097/ccm.0000000000000865] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gibbons C, Creese J, Tran M, Brazil K, Chambers L, Weaver B, Bédard M. The psychological and health consequences of caring for a spouse with dementia: a critical comparison of husbands and wives. J Women Aging 2015; 26:3-21. [PMID: 24483280 DOI: 10.1080/08952841.2014.854571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.
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Affiliation(s)
- Carrie Gibbons
- a Research Department , St. Joseph's Care Group , Thunder Bay , Ontario , Canada
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Haley WE, Roth DL, Hovater M, Clay OJ. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology 2015; 84:1323-9. [PMID: 25740862 DOI: 10.1212/wnl.0000000000001418] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Three-year changes in well-being were studied among family caregivers of an epidemiologically derived sample of stroke survivors from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and compared to matched noncaregivers. METHODS Family caregivers of REGARDS participants who experienced a stroke event completed telephone interviews assessing depressive symptoms, mental and physical health quality of life (QOL), life satisfaction, and leisure satisfaction at approximately 9, 18, 27, and 36 months after the stroke (n = 235). For each stroke caregiver, a family member of a stroke-free REGARDS participant was enrolled as a matched noncaregiving control (n = 235) and completed similar interviews. RESULTS Multilevel longitudinal models found that caregivers showed poorer well-being at 9 months poststroke than controls on all measures except physical health QOL. Significant differences were sustained for 22 months after the stroke event for depressive symptoms, 31 months for mental health QOL, and 15 months for life satisfaction. For leisure satisfaction, differences were still significant at 36 months poststroke. Caregiving effects were similar across race and sex. CONCLUSIONS Stroke caregiving is associated with persistent psychological distress, but life satisfaction, depression, and mental health QOL became comparable to noncaregivers by 3 years after stroke. Caregiver leisure satisfaction was chronically lower than in noncaregivers. Intervention for stroke caregivers should recognize both the strains faced by caregivers and their capacity for successful coping over time.
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Affiliation(s)
- William E Haley
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham.
| | - David L Roth
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Martha Hovater
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
| | - Olivio J Clay
- From the School of Aging Studies (W.E.H.), University of South Florida, Tampa; the Center on Aging and Health (D.L.R.), Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, MD; and the Department of Biostatistics, School of Public Health (M.H.), and the Department of Psychology (O.J.C.), University of Alabama at Birmingham
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Hayes J, Chapman P, Young LJ, Rittman M. The Prevalence of Injury for Stroke Caregivers and Associated Risk Factors. Top Stroke Rehabil 2015; 16:300-7. [DOI: 10.1310/tsr1604-300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The relationship among caregiving characteristics, caregiver strain, and health-related quality of life: evidence from the Survey of the Health of Wisconsin. Qual Life Res 2014; 24:1397-406. [PMID: 25427430 DOI: 10.1007/s11136-014-0874-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In order to better understand how family caregiving may contribute to poor health outcomes, this study sought to determine (1) if and to what extent caregiving characteristics were associated with caregiver strain and health-related quality of life (HRQoL), and (2) whether caregiver strain mediated this association. METHODS Data were from the 2008-2010 Survey of the Health of Wisconsin, a representative sample of Wisconsin adults aged 21-74 years. Participants completed questionnaires about their caregiving, sociodemographics, and HRQoL; 264 caregivers were identified. Staged generalized additive models assessed the associations among caregiving characteristics, caregiver strain, and HRQoL; survey weights were applied to account for the complex sampling design. RESULTS More hours per week of care and greater duration of caregiving were associated with higher levels of strain. Greater caregiver strain was in turn associated with worse mental HRQoL. However, most caregiving characteristics were not directly associated with mental or physical HRQoL. CONCLUSIONS The findings suggest a chains-of-risk model in which caregiving may increase strain, which may in turn adversely influence mental HRQoL. Using this perspective to refine interventions may improve our ability to support caregivers on practice and policy levels.
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Williams NA, Hankey M. Support and negativity in interpersonal relationships impact caregivers' quality of life in pediatric food allergy. Qual Life Res 2014; 24:1369-78. [PMID: 25394894 DOI: 10.1007/s11136-014-0862-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined interpersonal relationship processes as they relate to health-related quality of life (HRQL) in caregivers of food-allergic children. Research questions explored the relative contributions of social support and social negativity to caregivers' adaptation as well as mechanisms of moderation, mediation, and moderated mediation through which these influences affect the association of time since children's food allergy diagnosis to caregivers' HRQL. METHODS Caregivers (N = 299) of food-allergic children were recruited from parent groups associated with a food allergy nonprofit organization. Participants completed web-based questionnaires assessing demographics and child allergy characteristics, the extent of support and negativity experienced in their social relationships related caregiving, and their HRQL. Multiple regression analyses were used to examine relations among time since diagnosis, interpersonal relationship processes, and caregiver HRQL. RESULTS Social negativity was directly related to diminished caregiver HRQL and was a stronger predictor of caregiver HRQL than social support. The effect of time since diagnosis on caregiver HRQL was indirect through social support, and this mediating effect did not depend on caregivers' experience of social negativity. CONCLUSIONS Interpersonal relationship processes appear influential in the adaptation of caregivers in the context of pediatric food allergy. Psychosocial interventions targeting support and negativity in caregivers' social relationships may help improve their HRQL.
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Affiliation(s)
- Natalie A Williams
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, 131 Home Economics Building, Lincoln, NE, 68588-0236, USA,
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Liu Y, Kim K, Zarit SH. Health trajectories of family caregivers: associations with care transitions and adult day service use. J Aging Health 2014; 27:686-710. [PMID: 25348275 DOI: 10.1177/0898264314555319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study examines family caregivers' health changes over 1 year on four health dimensions and explores the association of differential health trajectories with adult day service (ADS) use and caregiving transitions. METHOD The participants were 153 primary caregivers of individuals with dementia (IWDs) who provided information on care situations and their own health at baseline, 6-month, and 12-month interviews. RESULTS Caregivers showed increasing functional limitations and decreasing bodily pain over time, whereas role limitation and general health perception remained stable. Furthermore, caregivers' trajectories of functional limitation were associated with their extent of ADS use at baseline and their relatives' placement. DISCUSSION Health is multidimensional; all dimensions of caregiver health do not change in a uniform manner. The findings underscore the importance of the association of caregiving transitions and caregiver health and the potential health benefits of ADS use for family caregivers.
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Affiliation(s)
- Yin Liu
- The Pennsylvania State University, University Park, USA
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Seeher KM, Low LF, Reppermund S, Slavin MJ, Draper BM, Kang K, Kochan NA, Trollor JN, Sachdev PS, Brodaty H. Correlates of psychological distress in study partners of older people with and without mild cognitive impairment (MCI) - the Sydney Memory and Ageing Study. Aging Ment Health 2014; 18:694-705. [PMID: 24588692 DOI: 10.1080/13607863.2013.875123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Psychological effects of supporting someone with mild cognitive impairment (MCI) are often overlooked. We aimed to establish correlates of psychological distress in study partners of individuals with and without nonclinical MCI. METHODS Demographic, psychosocial and health measures were obtained cross-sectionally from 714 participants (39% MCI) and study partners of a longitudinal community-based study on cognitive aging. Study partners (i.e. family members/friends) were categorized as providing support with instrumental everyday activities or not. Psychological distress was measured by the Kessler psychological distress scale. Multiple hierarchical regressions examined determinants of psychological distress within Pearlin's stress process model. RESULTS Psychological distress was generally low and not associated with MCI or whether study partners provided support or not. Instead, distress was greater if participants were male irrespective of study partners' sex and if study partners reported negative reactions to participants' behavioral symptoms, felt burdened by providing support and showed worse coping abilities; overall explaining 37% variance. Self-rated disability and aspects of health-related quality of life explained additional 7%. CONCLUSION Objective impairment measures were not associated with distress in partners or supporters. However, study partners' appraisals of functional and behavioral symptoms were linked to increased distress even in this very mildly affected community cohort.
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Affiliation(s)
- Katrin M Seeher
- a Dementia Collaborative Research Centre, School of Psychiatry, UNSW Medicine , University of New South Wales , Sydney , Australia
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Rosso AL, Lee BK, Stefanick ML, Kroenke CH, Coker LH, Woods NF, Michael YL. Caregiving frequency and physical function: the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2014; 70:210-5. [PMID: 25060315 DOI: 10.1093/gerona/glu104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Informal caregiving is common for older women and can negatively affect health, but its impact on physical function remains unclear. Using inverse probability weighting methods, we quantified the association of caregiving with physical function over 6 years. METHODS Study participants were 5,649 women aged 65 years and older at baseline of the Woman's Health Initiative Clinical Trial (multicenter recruitment, 1993-1998) with complete caregiving data and function at baseline and at least one follow-up. Caregiving was self-reported (low-frequency if ≤2 times per week and high-frequency if ≥3 times per week). Performance-based measures of physical function including timed walk (meters/second), grip strength (kilograms), and chair stands (number) were measured at baseline and years 1, 3, and 6. Associations and 95% confidence intervals of baseline caregiving with physical function were estimated by generalized estimating equations with inverse probability weighting by propensity and attrition scores, calculated by logistic regression of baseline health and demographic characteristics. RESULTS Over follow-up, low-frequency caregivers had higher grip strength when compared with noncaregivers (mean difference = 0.63kg, confidence interval: 0.24, 1.01). There were no observed differences between high-frequency caregivers and noncaregivers on grip strength or for either caregiver group when compared with noncaregivers on walk speed or chair stands. Rates of change in physical function measures did not differ by caregiving status. CONCLUSIONS Caregiving was not associated with poorer physical function in this sample of older women. Low-frequency caregiving was associated with better grip strength at baseline which persisted through follow-up. This study supports the concept that informal caregiving may not have universally negative health consequences.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University, School of Medicine, Palo Alto, California
| | | | - Laura H Coker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Nancy F Woods
- School of Nursing, University of Washington, Seattle
| | - Yvonne L Michael
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Ornstein K, Gaugler JE, Zahodne L, Stern Y. The heterogeneous course of depressive symptoms for the dementia caregiver. Int J Aging Hum Dev 2014; 78:133-48. [PMID: 24956922 DOI: 10.2190/ag.78.2.c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Caregiving may be burdensome to caregivers, negatively affecting health and impacting decisions to institutionalize patients. It is unclear how caregiver depression changes over longer periods or whether heterogeneous trajectories for caregivers are apparent. The goals of this article are to characterize the course of depressive symptoms among caregivers over time and to examine the impact of baseline patient and caregiver characteristics on these trajectories. Patients with dementia and their caregivers were followed every 6 months for up to 6 years or until death (n = 133). Growth mixture modeling identified trajectories of caregiver depression over time. Most caregivers had stable trajectories of symptoms, with a smaller subset showing evidence of wear-and-tear. Patient clinical characteristics had no impact on symptom course for caregivers. Future work should utilize a longitudinal perspective and consider that there may be heterogeneous trajectories for caregivers. Those caregivers who follow a wear-and-tear trajectory may require targeted interventions to improve outcomes.
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Abstract
Caregiving in a rural context is unique, but the experience of rural caregivers is understudied. This paper describes how rural caregivers cope with caring for a loved one diagnosed with mild cognitive impairment or dementia using qualitative description to generate a low-inference summary of a response to an open-ended question. This approach allowed these rural caregivers to describe their positive experiences in addition to the more commonly explored caregiver experiences related to stress. Analyses of coping revealed use of social support, engaging in relaxing and physical activity, and cognitive reframing. In addition, caregivers reported strong faith and religiosity, and to a lesser frequency behavioral changes, checking in with the person with dementia via telephone, and joint activity. Predominantly, these methods reflect approach-based strategies. The current data suggest that these caregivers manage well and adopt adaptive coping strategies to meet the demands of the caregiving role.
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