Impact of caregiving: listening to the voice of informal caregivers

Depression Mediates the Association Between Burden and Quality of Life in Informal Caregivers of Stroke Survivors: Meta-analytic Structural Equation Modeling

OBJECTIVE

This study aims to use Meta-analytical structural equation modeling (MASEM) to clarify the relationship between burden, depression, and quality of life in informal caregivers of stroke survivors.

DATA SOURCES

The databases of PubMed, Cochrane Library, Embase, China Knowledge Resource Integrated Database, Wan Fang Database, and Chinese Biomedical Database were comprehensively searched before January 16, 2023.

STUDY SELECTION

Two researchers performed an independent initial search by using a unified search strategy. Observational studies investigating the relation between burden, depression, and quality of life in informal caregivers of stroke survivors were included. The studies that met the inclusion criteria were appraised by "Quality Assessment and Validity Tool for Correlational Studies".

DATA EXTRACTION

PRISMA guidelines were used for this study. Data extraction was performed independently by 2 researchers. The following data were extracted: study author, year of publication, country, language, sample size, age, sex (%women), the caregivers' relation with stroke survivor, measures, type of outcome reported in the study, study design, and main conclusion.

DATA SYNTHESIS

The analysis included 18 articles that reported 23 effect sizes (N=3284). The MASEM findings showed that caregiver burden was positively associated with caregiver depression (β=0.474, 95% CI [0.398, 0.550]), caregiver depression was negatively associated with caregiver quality of life (β=-0.316, 95% CI [-0.545, -0.087]). Furthermore, the association between caregiver burden and quality of life was completely mediated by caregiver depression (β=-0.150, 95% CI [-0.271, -0.041]).

CONCLUSIONS

Using the MASEM approach, we observed that caregiver depression completely mediated the relation between burden and quality of life in informal caregivers of stroke survivors. Although the results did not allow for causal inference, this result suggested that for burdened stroke survivors' informal caregivers efforts should be made to their mental health to eliminate the internal barriers, then eventually improve their quality of life.

Through the Eyes of a Young Carer: A Photo Elicitation Study of Protective Resilience

Caregiving is recognised as a source of stress with potential for negative health impacts as well as positive outcomes and development of resilience. For young carers, children, and adolescents providing care for close family members, adaptation through resilience is crucial, yet work using a resilience approach is limited. This study explored protective factors and pathways to resilience in a sample of young carers, through application of the socioecological model in caring relationships. An in-depth qualitative approach was used, with in-person interviews facilitated by auto-driven photo elicitation. Deductive thematic analysis was applied, framed by three levels (individual, community, and society) of the socioecological model of resilience. Twelve participants (nine girls and three boys) aged 5-18 years, each providing care to a family member, were recruited using opportunity and volunteer sampling via carers' centres in the southwest of England. Ten key themes were identified, four at the individual level: pre-empting challenges and planning, cognitive strategies, emotional strategies, and seeking solitude; three at the community level: family support, friendships, and pets and inanimate objects; and three at the society level: professional support, access to caregiver activities and community, and being outdoors. The location of themes at each level indicated relevance of the socioecological model to identification of protective factors in a young carer population. These findings have important applications for guidance to charities and organisations supporting young carers. Identification of factors that promote resilience offers support for the development of well-informed interventions, which harness these protective factors to develop resilience and improve health for young carers.

Caregiver Burden in Adult Solid Organ Transplantation

The informal caregiver plays a critical role in supporting patients with various end-stage diseases throughout the solid organ transplantation journey. Caregiver responsibilities include assistance with activities of daily living, medication management, implementation of highly specialized treatments, transportation to appointments and treatments, and health care coordination and navigation. The demanding nature of these tasks has profound impacts across multiple domains of the caregiver's life: physical, psychological, financial, logistical, and social. Few interventions targeting caregiver burden have been empirically evaluated, with the majority focused on education or mindfulness-based stress reduction techniques. Further research is urgently needed to develop and evaluate interventions to improve caregiver burden and outcomes for the patient-caregiver dyad.

Factorial Structure and Psychometric Properties of the Spanish Version of the Pittsburgh Sleep Quality Index in Non-Professional Caregivers

Although sleep issues are among the symptoms commonly experienced by the non-professional caregiver population, and the Pittsburgh Sleep Quality Index (PSQI) is the most widely used instrument for the assessment of sleep quality, this has not been validated specifically for this population. The objective of this study was to analyze the factorial structure and psychometric properties of the Spanish version of the PSQI in a sample of Spanish non-professional caregivers. Trained clinical psychologists assessed sleep quality using the PSQI, as well as caregiver burden and psychological distress in 201 non-professional caregivers (87.1% female, Mage = 56.2 years). The internal consistency of the PSQI was 0.75. The two-factor model (Sleep quality and Disturbances) had an acceptable fit to the data, was found to be superior to the one-factor model, and more parsimonious than the three-factor model. There was a significant correlation between the PSQI and caregiver burden, as well as between the PSQI and psychological distress (p < 0.001 in all cases). A total score ≥ 9 allowed the identification of caregivers with possible anxiety and depression disorders (sensitivity 70.5%, specificity 71.9%). The results show that the PSQI is a reliable and valid instrument for the assessment of sleep quality in caregivers.

Unfolding What Self-Compassion Means in Young Carers' Lives

Young carers (YCs) are children and youth who provide caregiving for family members who may experience an illness, disability, addiction, language barriers, and/or age-related needs. Many of them show compassion towards others and continue to put their family members' needs before their own. They also report having no time for other activities or for themselves due to the caregiving role. Self-compassion might allow YCs to be kind to themselves, be mindful of their emotions, and understand that others, like them, go through similar experiences. While the relationship between outward and inward compassion has been examined in past research, studies have yet to determine YCs' self-compassion level in the context of providing care for others. The purpose of this qualitative study was to gain a better understanding of what compassion and self-compassion meant for YCs and whether they saw themselves as self-carers in addition to being caregivers. Six focus groups with YCs ages 12 to 18 years (n = 33) were conducted. Eight boys and 26 girls were divided into younger and older focus groups. A constant comparison analysis yielded three major themes: characteristics of compassion, self-compassion in YCs, and supports for self-compassion. Overall, YCs showed continual compassion for their loved ones, but despite understanding the value of self-care and self-compassion in one's lives, very few YCs displayed self-compassion. Some reported conflicts and tensions within them and between them and their family member(s). The role of parents and YC programs were addressed as a possibility for supporting self-compassion.

Caregiver burden versus intensity of anxiety and depression symptoms in parents of children with cerebral palsy as well as factors potentially differentiating the level of burden: a cross-sectional study (Poland)

OBJECTIVES

To assess the relationship between caregiver burden and severity of symptoms of anxiety/depression in parents of children with cerebral palsy (CP), and to identify factors differentiating the level of caregiver burden.

SETTING

Regional rehabilitation centres in South-Eastern Poland.

PARTICIPANTS

The study involved 190 parents of children with CP, that is, 138 women and 52 men.

PRIMARY AND SECONDARY OUTCOME MEASURES

Caregiver burden was assessed using Caregiver Burden Scale (CBS), while the intensity of anxiety and depression symptoms was measured using Hospital Anxiety and Depression Scale (HADS). Potential predictors were examined using Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Barthel Index (BI) as well as a questionnaire focusing on the characteristics of the child, the parent and the family. The analyses applied Pearson's linear correlation coefficient as well as multiple regression analysis.

RESULTS

All the CBS measures are significantly correlated to HADS-A (anxiety) and HADS-D (depression). Intensity of anxiety is most visibly linked to CBS measures of disappointment and environment (p<0.0001), while severity of depression is related to emotional involvement and general strain (p<0.0001). The factors differentiating caregiver burden measure in the subscales of general strain (p<0.0001) and social isolation (p<0.0001) include the child's age and BI, and the parent's health status; in the subscale of disappointment (p<0.0001)-the child's age, BI, GMFCS, as well as the parent's age and health status; in the subscale of emotional involvement (p=0.0007)-BI, and the parent's health status; in the subscale of environment (p=0.0002)-the child's age and BI.

CONCLUSIONS

There is a positive linear relationship between the caregiver burden measures and severity of anxiety and depression. Effort should be made to relieve caregiver burden in parents of children with CP.

Dignity of informal caregivers of migrant patients in the last phase of life: a qualitative study

Background

A key aim of palliative care is to improve the quality of life of patients and their families. To help ensure quality of life for the families of patients with migrant backgrounds, this study sought insights into the dignity of informal caregivers in migrant communities. This could improve understanding of family-centered care for migrant patients.

Methods

Twenty semi-structured interviews with informal caregivers of Turkish, Moroccan, or Surinamese background living in the Netherlands were analyzed thematically.

Results

The dignity of the patient and that of their informal caregivers were found to be strongly interrelated. Most important for the dignity of caregivers was ensuring good care for their patients and preserving the patients’ dignity. Ensuring good care involved advocating for good and dignified care and for satisfaction of a patient’s wishes. For many informal caregivers, it also included delivering care to the patient by themselves or together with other family members, despite having to give up part of their own lives. Providing care themselves was part of maintaining a good relationship with the patient; the care was to cater to the patient’s preferences and help preserve the patient’s dignity, and it could be accompanied by valuable aspects such as times for good conversations. Positive interaction between an informal caregiver and a patient positively influenced the informal caregiver’s dignity. Informal caregiver and patient dignity were often compromised simultaneously; when informal caregivers felt healthcare professionals were undermining a patient’s dignity, their own dignity suffered. According to informal caregivers, healthcare professionals can help them preserve dignity by taking seriously their advice about the patient, keeping them informed about the prognosis of the disease and of the patient, and dealing respectfully with differences in values at the end of life.

Conclusion

The dignity of migrant patients’ informal caregivers in the last phase of a patient’s life is closely entwined with ensuring good care and dignity for the patient. Healthcare professionals can strengthen the dignity of informal caregivers by supporting their caregiving role.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00721-6.

Seniors' campus continuums: local solutions for broad spectrum seniors care

BACKGROUND

As demand and desire to "age-in-place" grows within an aging population, and new areas of need emerge, governments nationally and internationally are focusing effort and attention on innovative and integrative approaches to health and well-being. Seniors' Campus Continuums are models of care that seek to broaden access to an array of services and housing options to meet growing health and social needs of aging populations. The objective of this study is to increase understanding of this model and factors that influence their evolution, development, ongoing functioning and capacity to integrate care for older adults wishing to age in their own home and community.

METHODS

This research uses a comparative case study approach across six-bounded cases offering four geographically co-located components (mixed housing options, internal and external community supports, and a long-term care home) in various contexts across Ontario, Canada. Onsite in-person and phone interviews with senior campus staff (N = 30), and campus partners (N = 11), enhanced by direct observation at campuses explored historical and current efforts to offer health, housing and social care continuums for older adults.

RESULTS

Analysis highlighted eight key factors. Enabling factors include i. rich historical legacies of helping people in need; ii. organizational vision and readiness to capitalize on windows of opportunity; iii. leveraging organizational structure and capacity; iv. intentional physical and social design; v. broad services mix, amenities and innovative partnerships. Impeding factors include vi. policy hurdles and rigidities; vii. human resources shortages and inequities; and viii. funding limitations. A number of benefits afforded by campuses at different levels were also observed.

CONCLUSION

Findings from this research highlight opportunities to optimize campus potential on many levels. At an individual level, campuses increase local access to a coordinated range of health and social care services, supports and housing options. At an organizational level, campuses offer enhanced collaboration opportunities across providers and partners to improve consistency and coordination of care, and improved access to shared resources, expertise and infrastructure. At a system level, campuses can address a diversity of health, social, financial, and housing needs to help seniors avoid premature or inappropriate use of higher intensity care settings.

"Caring for the Elderly is Very Difficult": Challenges and Coping Strategies of Caregivers in Urban Poor Accra, Ghana

This study is part of a broader phenomenological study on the experiences of family caregivers and their care recipients. There is a general paucity of research on the experiences of primary and secondary caregivers, and the negative impact of elderly care on caregivers in the urban poor settings in Ghana. This study explored primary and secondary caregivers' challenges and coping strategies in the urban poor context in Accra, Ghana. This study was conducted in Ga Mashie. Thirty-one caregivers were interviewed. A phenomenological analysis was conducted using NVivo 10. Primary and secondary caregivers experienced economic, physical, social, and psychological burdens. Also, caregivers used spirituality and perseverance to cope with their challenges. The findings demonstrate that caregivers' challenges varied by type of caregiver. Researchers and policymakers should consider the type of caregiver when designing interventions to mitigate the negative impacts of family caregiving on caregivers.

Burden of Care in Caregivers of Iranian patients with chronic disorders: a systematic review and meta-analysis

Introduction

Caring for patients with chronic disorders can lead to different problems for caregivers in physical, psychological, social, family, and financial domains. High levels of burden of care can make caregivers vulnerable to physical and psychological conditions and influence their quality of life. Therefore, the goal of the present study was to estimate the overall percentage of burden of care in caregivers of Iranian patients with chronic disorders.

Methods

A total of 25 articles published from inception to February 2019 were reviewed. Search for articles was conducted in international (Scopus, Web of Science, and PubMed) and domestic (Scientific Information Database (SID) and MagIran) databases, using the following keywords: “Caregiver,” “Burden,” and “Iran,” and their possible combinations. The data were analyzed using the meta-analysis method and the random effects model. All the analyses were performed using STATA, version 14.

Results

The overall percentage of burden of care in caregivers of Iranian patients with chronic disorders was 53.28% (95% CI: 46.13–60.43). The highest percentage of burden of care was related to dialysis (62.75; 95% CI: 56.11–69.38), mental disorders (58.69; 95% CI: 49.70–67.69), and Alzheimer’s disease (57.07; 95% CI: 46.23–67.92), respectively; and the lowest percentage of burden of care was related to diabetes (34.92; 95% CI: 18.01–51.82).

Conclusions

Caregivers of Iranian patients with chronic disorders experience high levels of burden of care, especially those caring for patients undergoing dialysis, patients with mental disorders, and patients with Alzheimer’s disease. Therefore, necessary measures need to be taken by Iranian health care officials to reduce burden of care in caregivers.

Coping strategies of family caregivers in spinal cord injury: a qualitative study

Purpose: To identify the coping strategies used by family caregivers of persons with spinal cord injury (SCI) in Switzerland in order to develop tailored support programs.Materials and methods: Purposive sample of >18 years participants, speaking an official Swiss language fluently, being family caregivers of persons with SCI for at least 4 years, and perceiving either a high or low burden in relation to caregiving. Data were collected through face-to-face semi-structured interviews (N = 22). Thematic analysis was performed.Results: Four main coping strategies were identified: reappraisal, active acceptance, setting limits to the caregiver role, and seeking support. These strategies can be used one at a time or combined, and at different times of a caregiver pathway. Our analysis highlighted that caregivers need skills to implement these strategies (e.g., self-evaluation skills).Conclusions: Caregivers of persons with SCI develop cognitive coping strategies to make sense of the situation and establish a "new normal" and problem-focused coping strategies to deal with their new tasks and role. These strategies do not seem to be typical only of SCI caregivers. Hence, interventions that worked for caregivers in other fields could be adapted. Rehabilitation centers should systematically integrate programs targeted to caregivers into their offerings.IMPLICATIONS FOR REHABILITATIONHealthcare systems need to develop educational and support measures for both persons with a health condition and their caregivers.Caregivers should become long-term partners in rehabilitation and a regular and structured needs assessment should be offered.Interventions that worked for caregivers in other fields can be adapted to support also caregivers in SCI.Educational and support programs dedicated to caregivers should teach not only how to perform caregiving tasks but also how to balance between responding to the care recipient's needs and their own needs.

Caring for a stroke patient: The burden and experiences of primary caregivers in Uganda - A qualitative study

Aim

We assessed the burden and experiences of caregivers looking after stroke patients in Kampala, Uganda.

Design

We conducted a qualitative cross‐sectional study between May 2018–July 2018 among primary caregivers of stroke patients.

Methods

The primary caregiver was defined as the person spending most of the time providing daily care for the stroke patient for at least four months. Purposive sampling was used to consecutively recruit the primary caregivers. In‐depth interviews were conducted, and audiotape recorded, and observations were also made. Data were managed using NVIVO 12.0 following thematic approach.

Results

Twenty‐five caregivers were included in the analysis with a mean age of 39.3, SD 10.7. Four themes were identified from the qualitative analysis on caregivers’ experiences of looking after stroke patients: taking on new responsibilities, factors that protected caregivers from breaking down, limited resources and experiences with patient outcomes. Our findings highlight the need for interventions to support stroke patients and their caregivers.

Qualitative exploration of the experiences of informal care-givers for dependent older adults in Mexico City

Population ageing and increasing prevalence of chronic diseases and their consequences, changes in family structure and a decrease in the potential pool of family care, increase the need for formal long-term care for older adults in Mexico, and the need to understand the experiences of informal care-givers and how this impacts their social, family and personal conditions. This study investigates the experience of informal care-givers of dependent older adults using a cross-sectional qualitative study with an ethnographic focus. Thematic analysis was performed. The study comprised 48 semi-structured interviews with care-givers of dependent older adults who are beneficiaries of an in-home medical programme in Mexico City. The average age of care-givers was 54.7 years (standard deviation = 13.1, range = 24–86) and 75 per cent (36) were women. Results show care-giving experiences are diverse and complex, and profoundly affect the care-giver's life in terms of emotional burden, health deterioration and adverse life conditions due to economic deprivation. They also revealed key aspects such as the need to improve communication between care-givers and health-care personnel, the need for training about specific care needs and opportunity costs incurred. This information can serve as a basis for generating support strategies that may be integrated into the in-home programme. It is essential to promote actions that consider the ‘dependent older adult–informal care-giver’ dyad, and that aim to reduce the care-giving burden.

Coping and adjustment in caregivers: A systematic review

This systematic review assessed coping and adjustment in caregivers of all ages to provide a synthesis of existing literature in the context of methodological approaches and underlying theory. Four databases were searched. Reference lists, citations and experts were consulted. In total, 27 studies (13 quantitative and 14 qualitative) were included. Coping factors associated with adjustment (problem- versus emotion-focussed coping and cognitive strategies) and psychosocial factors associated with physiological adjustment (trait anxiety, coping style and social support) were identified. Results raised methodological issues. Future research requires physiological adjustment measures and longitudinal assessment of the long-term impact of childhood caregiving. Findings inform future caregiver research and interventions.

Progressive exhaustion: A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis

Objective

The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers.

Methods

In this qualitative study, a content analysis approach was used for data collection and analysis. Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Semi-structured interviews were held to collect data.

Results

Four categories were developed as follows: ‘care challenges’, ‘psychological vulnerabilities’, ‘the chronic nature of care ’and “care in the shade”. The categories led to the development of the main theme of ‘progressive exhaustion’ experienced by the family caregivers during the provision of care to patients undergoing hemodialysis.

Conclusion

Family caregivers have a significant role in the process of patient care, and this role leads them to progressive exhaustion; therefore, the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life, social welfare, and satisfaction level.

Caregiving burden of children with chronic diseases

BACKGROUND

The care demands of children with chronic diseases can affect caregivers' health by imposing caregiving burden to them. The health status of caregivers plays a vital role in the quality of care provided to such children and in their quality of life.

OBJECTIVE

To determine caregiving burden in caregivers and to identify relevant influential factors.

METHODS

In this cross-sectional study, a total number of 249 caregivers of children with chronic diseases who referred to hospitalization and ambulatory departments of Bandar Abbas, Iran in 2016 were selected using convenience sampling method. The main caregivers who were older than 18 years and provided care to a sick child for at least three months consecutively were included. Caregiving burden was measured using the Caregiver Burden Scale. Data was analyzed SPSS 16 using descriptive statistics, Spearman's correlation coefficient and Mann-Whitney U test.

RESULTS

Mean score of caregiving burden was 1.98 which was close to moderate level. The highest caregiving burden was observed in general strain dimension (2.35), and cerebral palsy imposed the maximum burden to caregivers (2.24). Correlation coefficient revealed that perceived caregiving burden was in connection with children's and caregivers' age, duration of disease and caregiving, child's level of disability, number of family members and income level (p<0.05). Mann-Whitney U test showed that female caregivers, villagers, and caregivers dealing with more than one patient experienced higher burden (p<0.05).

CONCLUSION

Different variables can increase caregiving burden. Therefore, planning for holistic and family-centered interventions to decrease caregiving burden is necessary for health care providers.

Caregiver burden and the medical ethos

Are physicians sometimes morally required to ease caregiver burden? In our paper we defend an affirmative answer to this question. First, we examine the well-established principle that medical care should be centered on the patient. We argue that although this principle seems to give physicians some leeway to lessen caregivers' suffering, it is very restrictive when spelled out precisely. Based on a critical analysis of existing cases for transcending patient-centeredness we then go on to argue that the medical ethos should indeed contain a rule requiring physicians to alleviate caregiver burden under certain circumstances. Finally, we apply our findings to deep brain stimulation (DBS) for Parkinson's disease. We present empirical data from a recent study of DBS indicating that spousal caregivers of Parkinson patients treated with DBS are sometimes deeply troubled by the effects of the therapy and discuss what moral obligations the treating physicians may have in such cases.

Lived experiences of Iranian parents of beta-thalassemia children

INTRODUCTION

Thalassemia is a chronic blood disease, which imposes adverse effects on patients and their families. Parents of such patients, given that they had the thalassemia trait, hold themselves responsible for their children's disease in addition to other difficulties, bear the burden of guilt and hopelessness and worry about the health and future of their children. This study aimed to explore the lived experiences of parents of children with thalassemia.

METHODS

The present research was conducted using a descriptive phenomenological approach. A purposive sampling was carried out until data saturation. Participants included 15 parents of children with thalassemia who were referred to the Thalassemia Center of Zabol to perform therapeutic procedures for their child in 2016.

RESULTS

Extracted interviews were analyzed employing Colaizzi's method, and four main themes were obtained, including "Gray marriage consanguinity", "Burdened with increased number of thalassemia children", "Socio-familial worries" and "Inexpressible wishes for having an ideal society".

CONCLUSION

The results revealed that parents of children with thalassemia experience a wide range of problems in different aspects, such as physical, emotional, mental, social, economic and familial dimensions. Their experiences are valuable and can help in achieving a better understanding of their problems, which in turn can enable the members of the treatment team to play a more active role and the society to have a better understanding of this disease.

Care Burden and Social Support Levels of Caregivers of Patients with Chronic Obstructive Pulmonary Disease

This descriptive study was conducted to determine the care burden and social support levels of caregivers to patients with chronic obstructive pulmonary disease (COPD). The primary caregivers of 112 patients with COPD hospitalized in the chest diseases service of a university hospital were involved in the study. Data of the study were collected by using the Patient and Caregiver Information Form, which was prepared by reviewing the literature, Katz Index of Independence in Activities of Daily Living, Zarit Burden Interview, and Multidimensional Scale of Perceived Social Support. While the care burden mean score of caregivers of patients with COPD was 40.91 ± 20.58, the mean score of Multidimensional Scale of Perceived Social Support was 54.13 ± 18.84. In this study, it was determined that female caregivers, as well as individuals stating that their physical and psychological health was affected and those having difficulty giving care and needing help, had higher levels of care burden, whereas the spouses, as well as individuals with lower levels of income and those stating that their physical and psychological health was affected, had lower levels of social support.

The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions

Rare diseases are often life-limiting conditions, the majority of which require constant caregiving needs. The realization of a spectrum of palliative care throughout the trajectory of rare diseases could ensure individualized and caregiver-focused approaches to the care of patients and families. In June 2015, the National Institute of Nursing Research (NINR), the lead institute at the National Institutes of Health for end-of-life research, in conjunction with the National Center for Advancing Translational Sciences, Office of Rare Diseases Research (ORDR) held an interdisciplinary workshop on the unique challenges of caregiving and palliative care in adult and pediatric rare diseases. The panel identified gaps in current knowledge, and afforded suggestions for research opportunities in palliative care science to improve the care of individuals with serious, advanced, rare diseases and their caregivers. This meeting provided an in-depth opportunity to incorporate new concepts into palliative and end-of-life care for individuals with a range of rare diseases and their caregivers. This report presents a summary of the workshop.

Impacts of care-giving and sources of support: a comparison of end-of-life and non-end-of-life caregivers in Canada

This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life (EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non-EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey (GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non-EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non-EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non-EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers.

Never-pregnant African American adolescent girls' perceptions of adolescent pregnancy

Despite the decrease in adolescent pregnancy rates, rates among African American girls remain higher than other racial/ethnic adolescent groups. This descriptive qualitative study explored never-pregnant African American adolescent girls' perceptions about adolescent pregnancy. Sixty-four participants participated in individual interviews and focus groups. Individual interviews examined beliefs about adolescent pregnancy and perceptions of life changes resulting from becoming pregnant during adolescence. Focus groups were held to validate findings from the interviews. Participants agreed that becoming pregnant during adolescence would negatively impact their education, family, and peers. Participants anticipated feelings of shame and embarrassment in the event that they became pregnant.

Costs and benefits of home care for the elderly versus residential care: a comparison using propensity scores

A comparison of the costs of residential care and home care shows that the former is more expensive for society. However, elderly people seem to be happier in residential care. All stakeholders, except the state (and thus the taxpayer), benefit if elderly people enter residential care. This reveals that payment systems in the Netherlands contain adverse incentives stimulating entry into residential care. The research is based on surveys of older people in the Netherlands living at home and those living in residential care homes in the period 2007-2009. Propensity score matching is used to match people living at home with those living in residential care. All costs of living and health care are compared for these two groups.

Building collaboration in caring for people with schizophrenia

People with schizophrenia, who have disturbances in mood, thought processes and behavior, experience impairment in day-to-day functioning. Primary caregivers have tried to become involved in caring for persons with schizophrenia by coordination with community psychiatric nurses. Community psychiatric nurses have an important role to play in supporting families in this care, especially primary caregivers. The purpose of the present study was to explore the relationship between Thai community psychiatric nurses and primary caregivers of people with schizophrenia. Grounded theory methodology was used to examine the process with which community psychiatric nurses work together with primary caregivers. Purposive sampling and theoretical sampling were used. Data were collected from 34 informants, including 17 community psychiatric nurses and 17 primary caregivers through in-depth interviews, observation, and field notes. Data was analyzed using constant and comparative methods by Glaser (1978). The study revealed that building collaboration in the care of people with schizophrenia involved coordinating both community psychiatric nurses and primary caregivers in a process that consists of five major stages. In the first stage, community psychiatric nurses and primary caregivers used strategies to establish trust in each other before the next stage, which engaged their concerns and needs. Later, the stages of mutual preparation for caregiving, cooperating on patient care and monitoring outcomes were jointly employed in order to promote a healthy family life for patients. The study concludes by suggesting guidelines and giving insights into ways of helping primary caregivers and their patients with schizophrenia.

Liminality as a conceptual frame for understanding the family caregiving rite of passage: an integrative review

Family caregiving is a significant rite of passage experienced by family caregivers of individuals with protracted illness or injury. In an integrative review of 26 studies, we characterized family caregiving from the sociocultural perspective of liminality and explored associated psychosocial implications. Analysis of published evidence on this dynamic and formative transition produced a range of themes. While role ambiguity resolved for most, for others, uncertainty and suffering continued. The process of becoming a caregiver was transformative and can be viewed as a rebirth that is largely socially and culturally driven. The transition to family caregiving model produced by this review provides a holistic perspective on this phenomenon and draws attention to aspects of the experience previously underappreciated. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Differential impacts of care-giving across three caregiver groups in Canada: end-of-life care, long-term care and short-term care

Using data from Statistic Canada's General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care-giving among three groups of caregivers providing informal care either in the caregiver's or recipient's home, or in other locations within the community: (i) those providing end-of-life (EOL) care (n = 471); (ii) those providing long-term care (more than 2 years) for someone with a chronic condition or long-term illness (n = 2722); and (iii) those providing short-term care (less than 2 years) for someone with a chronic condition or long-term illness (n = 2381). This study lays out the variation in sociodemographic characteristics across the three caregiver groups while also building on our understanding of the differential impacts of care-giving through an analysis of determinants. All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of 'fair or poor' self-assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care-giving, more so than both short-term and long-term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care-giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long-term or short-term caregivers. This provides the evidence for the assertion that EOL care-giving is the most intense type of care-giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short-term and long-term caregivers.

A psychometric analysis of the spiritual needs inventory in informal caregivers of patients with cancer in hospice home care

PURPOSE/OBJECTIVES

To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care.

DESIGN

A subanalysis of a longitudinal, randomized hospice clinical trial.

SETTING

Two hospices in the southwestern United States.

SAMPLE

410 informal caregivers of patients with cancer in hospice home care.

METHODS

To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted.

MAIN RESEARCH VARIABLES

Spiritual needs, depression, social support.

FINDINGS

The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89.

CONCLUSIONS

The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended.

IMPLICATIONS FOR NURSING

Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care.

Caring for a loved one with cancer: it is my job

This study investigated the experiences of caregivers of loved ones with cancer in Lomé, Togo. The authors developed a framework that captures the experiences of 17 caregivers. The framework explains the exploratory factors that influenced the lives of caregivers from the caregivers' own perspectives. Findings showed that even though the caregivers experienced significant challenges that affected their lives and the lives of their families, because of cultural norms and expectations, they tried their best to overcome the challenges. Although some reported positive impacts on their family functioning, others reported negative impacts such as fragmentation of the family unit. Implications for practice and policy are discussed.

A bridge between a lonely soul and the surrounding world: A study on existential consequences of being closely related to a person with aphasia

This study illuminates existential consequences of being closely related to a person suffering from aphasia. Seventeen close relatives were interviewed and their narratives were interpreted with inspiration from Ricoeur, Levinas, Husserl, Winnicot, and Maurice Merleau-Ponty. The emerging interpretations resulted in four themes that illuminate a life characterized by lost freedom, staying, a new form of relationship, and growing strong together with others. An overarching theme suggests that a life together with an aphasic person means being used as a bridge between the aphasic person and the surrounding world. Moreover, it illuminates that a close relative to a person with aphasia is a person who does not leave, despite a heavy burden of lonely responsibility. It is concluded that community services need to fulfill their responsibility of providing support to informal caregivers as suggested by the Swedish lawmakers.

Adjustment and coping in spousal caregivers following a traumatic spinal cord injury: an interpretative phenomenological analysis

Semi-structured interviews were conducted with 11 spousal caregivers to people with a traumatic spinal cord injury and were subjected to interpretative phenomenological analysis (IPA). Here, we present two inter-related master themes: (1) coping with the spousal caregiver role; and (2) putting the pieces back together again. Within these, the analysis describes how regular venting of emotion, social support and focusing on the positive aspects of the situation all promoted coping. Adjustment was reportedly hindered by the introduction of paid caregivers as this represented a loss of privacy and power for the participants. The findings are discussed in relation to the wider literature and recommendations for future caregiver support are highlighted.

Family interventions in early psychosis: specificity and effectiveness

The first episode of psychosis frequently occurs during adolescence and early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the early phases. However, the negative impact of psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later psychosis. In this paper, we review the literature on family interventions in early psychosis in the context of new evidence for its efficacy and its routine incorporation in early intervention services for psychosis.

Struggling in an inescapable life situation: being a close relative of a person dependent on home enteral tube feeding

AIM

To explore what it means to be a close relative of a person dependent on home enteral tube feeding (HETF) and how they can manage this situation.

BACKGROUND

Previous studies have shown that the situation of close relatives in home care in general can be burdensome and difficult. Research is scarce about experiences of close relatives when patients are treated with HETF.

DESIGN

A qualitative design was used, in accordance with grounded theory (GT).

METHODS

Twelve close relatives were interviewed twice, using open-ended questions. Five were relatives of patients supported by home care services or advanced home care teams. Using the GT method, sampling, data collection and data analysis were carried out simultaneously.

RESULTS

One core category, 'Struggling in an inescapable life situation' and eight categories were found. The situation led to involuntary changes in the lives of the close relatives, something they could do little about. Their lives had become completely upturned and restricted by the HETF. Togetherness and pleasure was lost and they felt lonely. The relatives faced a new role of being informal caregivers and they had to adjust their daily life accordingly. They felt forced to take on a heavy responsibility for which they lacked support. The close relatives struggled to manage and to make the best of their new situation.

CONCLUSIONS

This study highlighted the demands and vulnerability which is embedded in the role of being a close relative of a patient with HETF. It also pointed out their need for comprehensive support from the health care system.

RELEVANCE TO CLINICAL PRACTICE

Support to facilitate the situation of close relatives should be given from the health care. One way to organise the care could be through a nurse-led clinic, which provides continuous support, information and counseling.

Creating a new whole: helping families of people with schizophrenia

Collaboration between psychiatric nurses and family members is considered an important part of caring for people with schizophrenia either in hospital or at home after discharge. Studies have demonstrated family involvement in terms of caring for patients who have been discharged early from hospital. An extensive review of the literature and related studies regarding nursing interventions have been done, but there have been limited studies on what psychiatric nurses actually do when working with the families of people with schizophrenia in Thailand. The purpose of the present study was to explore relationships between Thai psychiatric nurses and families in terms of administering nursing care to patients. Grounded theory methodology was used to examine the processes through which psychiatric nurses work with families. Data were collected by 16 psychiatric nurses through in-depth interviews, observations, and field notes. Data were analyzed using constant and comparative methods of other studies, which revealed the process by which nurses can create a new whole between families, patients, and Thai psychiatric nurses. The process consists of four major stages: establishing trust, strengthening connections, promoting readiness to care, and supporting family.

“I Do the Best I Can”: Caregivers' Perceptions of Informal Caregiving for Older Adults in Belize

In this first study of informal caregiving for older adults in Belize, 29 caregivers described their experiences of caregiving, how they perceived and managed the role, and what critical resources they needed. The three main themes identified in the caregiver interviews were the experiences of caregivers, the rewards of caregiving, and navigating the caregiver role.

Caregivers identified positively with the role of care provider and they did not describe it as burdensome nor did they describe role strain. However, caregivers' complaints of poor physical health might be construed as somatic expressions of strain. The caregivers' religiosity was salient to how they viewed and coped with their caregiver role. In conclusion, culture appears to influence positively caregivers' beliefs and perceptions of caregiving in Belize. However, the expected increase in the older population and current circumstances of many caregivers and care recipients means there is a critical need for resources to support caregivers and promote aging in place.

What makes grief difficult? Perspectives from bereaved family caregivers and healthcare providers of advanced cancer patients

Objective:

Family members who take on the role of caregiving for someone who is dying begin bereavement after being emotionally and physically taxed by the caregiving experience. The course of bereavement is influenced by a number of factors, including health problems, financial concerns, social support, and family relationships. This paper reports on findings from a secondary analysis of qualitative data from a study examining family caregiver coping in end-of-life cancer care, to describe, from the perspectives of bereaved family caregivers, their perspectives on what made their grief difficult.

Method:

Qualitative data from three focus groups with family caregivers (n = 19) and two focus groups with health professionals (n = 14) were subjected to interpretive thematic analysis.

Results:

Our finding suggest three broad areas that make family caregivers' grief difficult: (1) dealing with occurrences in everyday life; (2) dealing with challenges specific to the caregiving situation; and (3) dealing with the healthcare system.

Significance of results:

The findings provide an important beginning point in understanding the types of issues that seem to make grief difficult for family caregivers of cancer patients at the end of life and can help professional groups to understand what is needed by family caregivers in terms of support and delivery of services.

Health status of caregivers of children with cerebral palsy

BACKGROUND AND AIMS

While a 'Family-Centered' approach to care is accepted as best practice in the context of childhood disability, it may lead to increased demands on family members by requiring them to be active participants in their child's care. This may impact upon the physical and mental health of the caregiver and therefore needs to be investigated. This study aimed to assess the health status of caregivers of children with cerebral palsy (CP) in Ireland and to identify vulnerable subgroups.

METHODS

A cross-sectional postal survey was conducted using a questionnaire incorporating the SF-36v2.0. The sample consisted of male and female caregivers of children with CP, representing all levels of ability. Two questionnaires were sent to each child's home; a total of 312 questionnaires were sent to the homes of 156 children.

RESULTS

Completed questionnaires were returned by 161 caregivers (100 women, 61 men) of 101 children, giving a response rate of 65%. Caregivers of children with CP were found to have poorer health than the Irish general population, for whom normative data exist. Female caregivers had poorer health than male caregivers in both the physical (P < 0.05) and mental health (P < 0.001) domains of the SF-36. Caregivers spending more time caring had significantly poorer mental health than those spending less time caring (P < 0.05). There was no difference in the health of caregivers of 'more independent' versus 'more dependent' children, apart from the latter group reporting higher levels of bodily pain (P < 0.05).

CONCLUSION

This study provides evidence of the inferior health status of caregivers of children with CP in Ireland, particularly that of women.

Impact of mental health and caregiver burden on family caregivers' physical health

Caregivers providing care to chronically ill family members at home are potentially at risk for caregiver burden and declining physical and psychological health. This study aims to understand how family caregivers' mental health and caregiver burden affects physical health simultaneously, controlling for factors such as age, education level, caring hours per day, and emotional, functional, and physical support systems used by caregivers. We recruited 388 caregivers from Kaohsiung and Pingtong region in Taiwan. Caregivers had to be 18 years or older and spend most of their time taking care of an ill family member at home. Mental health was assessed by the 12-item Chinese Health Questionnaire (CHQ-12) and burden was measured using a modified scale for caregiver's burden. Health status was assessed by self-perceived health (SPH), illness symptoms and the number of diagnosed chronic diseases. A high number of hours per day of caregiving was associated with low emotional support and SPH, poor mental health and high burden. Higher emotional support was associated with better mental health and fewer illness symptoms. Higher physical support was associated with poorer mental health, higher burden, a greater number of illness symptoms and chronic diseases, and a lower SPH score. Hours per day of caregiving, and use of emotional, functional, and physical support were associated with mental health, and the hours per day of caregiving and use of physical support were predictors of burden. Mental health and burden were significantly associated with caregivers' health problems simultaneously. Our results show the important influence of mental health on caregivers' physical health. Interventions for caregivers need to target health in a holistic way.

Strangers, Patients, Monsters, Jailers, or Children: How South African Caregivers View Their Partners with Manganese Poisoning

Manganese poisoning (MP) is one of many chronic, degenerative conditions that result in spousal caregiver stress. Partners who were once fully functioning become strangers to those who love them. In time, spousal caregivers may come to view their erstwhile partners as patients, jailers, monsters, or bratty children. We explore spousal caregiver perceptions of loved ones with MP, based on the narrated experiences of five full-time South African carers and develop a typology of carer experiences, which contributes to an understanding of manganese poisoning, in particular, and to caregiving theory, in general. The findings contribute to practice by providing service providers with a rich understanding of carer stress and coping, in general, and the stress of those caring for partners with MP, in particular. Such richer understanding should extend service provider empathy and encourage appropriate, supportive intervention.

The experience of being a middle-aged close relative of a person who has suffered a stroke--six months after discharge from a rehabilitation clinic

Being a close relative brings with it a large number of consequences, with the life situation changing over time. The aim of this study was to illuminate the experiences of being a middle-aged close relative of a person who has suffered a stroke 6 months after being discharged from a medical rehabilitation clinic. Narrative interviews were conducted with nine middle-aged close relatives and analysed using a content analysis with a latent approach. The analysis revealed that being close to someone who had suffered a stroke 6 months after discharge meant; a struggling for control and a renewal of family life in the shadow of suffering and hope. The middle-aged close relatives began to perceive the changed reality. They were struggling to take on something new, become reconciled and find a balance in their family life. Their ability to work, relief from caring concerns and having support and togetherness with others seemed to be essential for the close relatives in their efforts to manage their life situation and maintain their well-being. Having reached the 'halfway point' in their lives and still with half of their life in front of them created worries. They felt dejected about their changed relationships and roles, experience a sense of loss of shared child responsibilities, a negative impact on their marital relationships and sexual satisfaction. They felt trapped in a caring role and they worried about how to endure in the future. The middle-aged close relatives' experiences were of being alone and neglected, in an arduous and complex life situation filled with loss and grief. The findings highlights that health professionals need to see and listen to the close relatives' experiences of transition in order to provide appropriate support adjusted to their varying needs during a time of renewal.

Informal carers of older family members: how they manage and what support they receive from respite care

AIMS

To describe informal carers' coping strategies and their experiences of the support provided by respite care.

BACKGROUND

The target set in the Finnish national old age policy strategy is that 90% of the population over 75 should be able to live at home. A major source of support for older people and their families is respite care in an institution.

DESIGN

Survey.

METHODS

The data were collected among informal carers who regularly use respite care services (n = 143). Two structured questionnaires were used: the Carers' Assessment of Managing Index (Nolan et al. 1995) and an index developed by the researchers.

RESULTS

Informal carers who provided care for younger individuals or people who needed less help had a better quality of life. Spouse carers and older informal carers were less satisfied with their quality of life than younger carers. Periods of respite care had a major influence on informal carers' quality of life: 93% said they felt invigorated. Care periods remained rather isolated episodes in the lives of the older patients in that there was hardly any discussion at the institution about the family's situation, the objectives of respite care, or about how the informal carer was coping. Altogether, 47% of the nurses remained fairly distant. The most useful coping strategies involved creating alternative perspectives in the caring relationship.

CONCLUSIONS

The results strengthen the knowledge base of informal caregiving by showing how caregivers cope and what kind of support they need in their demanding caring role.

RELEVANCE TO CLINICAL PRACTICE

Respite care nurses should invest greater effort in supporting informal carers. The service should be developed as an integral part of home care for older people. Nurses and informal carers should see each other as partners who share a common goal, i.e. the well-being of the entire family.

Filhas que cuidam de pais/mães com provável/possível Doença de Alzheimer

Este estudo investigou 32 filhas cuidadoras de pais/mães com provável/possível doença de Alzheimer (DA). Objetivou avaliar as reações iniciais delas diante do diagnóstico; as concepções sobre as características pessoais dos portadores antes e após a DA; os principais motivos que levaram a cuidar de seus genitores e quais os sentimentos diante do papel exercido. Elaborou-se uma entrevista que foi gravada, transcrita e analisada segundo a técnica de Bardin (1977/2000). Constatou-se que elas apresentaram uma reação inicial desfavorável diante da doença. Os motivos mais apontados para exercerem o papel, foram os sentimentos de obrigação filial e gratidão. No geral, elas não se sentiam bem executando essa tarefa. Entrementes, benefícios foram apontados por algumas, tais como crescimento pessoal. Conclui-se que a atividade de cuidar é heterogênea, multifacetada e as avaliações subjetivas das entrevistadas eram influenciadas por crenças, regras familiares, relacionamento com o idoso e percepções acerca da velhice e do cuidado.

ALS: Family caregiver needs and quality of life

The goal of this study was to determine the needs of ALS family caregivers. Utilizing a qualitative and quantitative mixed methodology known as Concept Mapping (CM), individual interviews with family caregivers of ALS patients (n =19) identified 109 needs. The needs were sorted and rated by 12 of the family caregivers, then analyzed using multidimensional scaling and cluster analysis. In addition, the caregivers completed the SF-8 QoL measure. The analysis resulted in a four-cluster map, representing the trajectory of the ALS family caregivers' needs: Stage 1: Early Coping and Adjustment; Stage 2: Maintenance; Stage 3: Transition to End Stage; and Stage 4: Coping with Change and Loss. The SF-8 results indicated that caregivers who resided with their ALS family member have poorer mental and physical health than family caregivers who did not have primary residence with the ALS patient. In conclusion, a model of needs for ALS family caregivers was established. Future studies addressing these needs may improve QoL of ALS family caregivers as well as ALS patients.

Gender roles and informal care for patients with AIDS: a qualitative study from an urban area in Tanzania

As HIV/AIDS imposes an overwhelming pressure on the capacity of an already overburdened health care system in many African countries, families have increasingly been noted to supplement hospital care services for patients with AIDS. The aim of the present study is to generate knowledge on the experiences of family caregivers to the patients with AIDS at the household level in Dar es Salaam, Tanzania. Data were collected through in-depth interviews with 20 family caregivers and were analyzed using thematic content analysis. The article provides the reader increased insight on the obligations that AIDS caregiving has imposed on women within the close kin group of the patient. The study indicates that caregiving has increased the workload and in the same vein the economic marginality of women, who themselves are increasingly widowed heads of households. The study findings demonstrate strong gendered implications for community and policy makers.

Spirituality expressed by caregivers of stroke survivors

Thirty-six caregivers of stroke survivors who are new to that role participate in a Web-based support and education intervention over the course of a year. The authors use a secondary analysis of a total of 2,148 e-mail messages that these caregivers posted to the intervention's discussion group. Rigorous content analysis is used to analyze the narrative data coded to spirituality (n = 230 e-mails). Four themes emerge and are drawn to Friedemann's (1995) framework of systemic organization: (a) feeling the presence of a greater power, (b) practicing rituals, (c) being one with nature, and (d) interacting with family and friends. Spirituality gives these caregivers hope and sustenance, but it also helps them express themselves more fully during a difficult time of change. The e-mail discussion data presented here highlight the importance of increased awareness of addressing spirituality in nurse-client encounters and designing interventions to support the caregivers.