Caring for Relatives with Dementia in Times of COVID-19: Impact on Caregivers and Care-recipients

Loneliness and social isolation among informal carers of individuals with dementia: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors.

METHODS

We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta-analysis. Subgroup analyses and meta-regression were employed to explore potential moderating variables and heterogeneity.

RESULTS

The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%-59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%-47.6%). Subgroup analyses and meta-regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools.

CONCLUSIONS

This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population.

Building community engagement with caregivers through online interaction and a salutogenic approach in a period of isolation

Background

Informal caregivers are essential figures that deal with the effects of dependence in the elderly. However, they suffer from poorer health-related quality of life, particularly regarding mental health. Social support is crucial, but this was suspended or dramatically reduced during the Covid-19 pandemic. Salutogenesis theory explores the contributing factors for the promotion and maintenance of health. Considering all these, we offered caregivers the opportunity to join a participatory project aimed at creating communication spaces where they could share experiences, think together about potential solutions, and explore which salutogenic actions they used in their daily basis and how they had changed during Covid-19 restrictions.

Methods

We used a qualitative methodology with a socio-constructivist and phenomenological approach and purposive sampling. We organized two focus groups consisting of online semi-structured discussions with seven participants in total. Conversations were videotaped and transcribed and we conducted content thematic analyses using the NVivo software.

Results

Caregiving in our setting are primarily women with high levels of education that do not always feel comfortable with this load because it interferes with their personal and professional lives. The pandemic increased caregivers feelings of loneliness, resignation, and burden, directly affecting their mental health. Furthermore, the disappearance of prevention programs and the difficulties to access healthcare services produced negative consequences on the already fragile elderly and their family caregivers.

Conclusion

The pandemic and its restrictions exacerbated the problematics affecting informal caregivers. Although these people are aware of their situation and have valued knowledge of how to improve their health, they cannot always put it into practice. We call policymakers to reframe interventions aimed at caregivers by introducing the voice of the community in the planning and to rethink the management of vulnerable people and their carers in other potential health crises.

The quality of family relationships in dementia: Mixed methods to unravel mixed feelings

Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.

Impact of the Pandemic Time on the Mental Health of People with Dementia and Their Family Caregivers in Brazil and Chile: One-Year Follow-Up

Background

Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer.

Objective

To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile.

Methods

This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61).

Results

In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07).

Conclusions

In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.

What Has the Pandemic Taught Us About Caregiving? Mental Health in Family Caregivers of People with Dementia One Year After the Lock-Down Due to the COVID-19 Pandemic

Caregiving for a person with dementia is considered a situation of chronic stress, with consequences on caregivers' physical and psychological health. The usual challenges of dementia care were intensified during the pandemic due to the risk of contagion, social isolation measures, and decrease in healthcare resources. The COVID-19 pandemic increased the stress both in the persons with dementia and their caregivers. This commentary reflects on the long-term effects of the pandemic on caregivers' mental health, focusing on the study by Olavarría and colleagues and drawing future research lines for culturally diverse family caregivers.

How to improve attitudes towards dementia? Reframing as a tool to overcome the stigma around Alzheimer's disease

OBJECTIVE

This article aims to determine how Alzheimer's disease (AD) framing impacts on attitudes and self-reported emotions towards the disease.

METHODS

We designed posters with framed messages based on the person with AD: Dualism of body and mind, Unity of body and mind, and control (Study 1, N = 261) and based on the relationship person with AD-family: No reciprocation, Good Mother, and control (Study 2, N = 240). To analyse the effect of the different frames, attitudes towards AD were measured twice (before and after the posters display). Emotions emerging from this exposure were also recorded.

RESULTS

Data analysis yielded four significant findings regarding communication on AD: (1) deproblematizing frames (i.e., Unity of body and mind and Good Mother) lead to a positive attitude change; (2) Non reciprocation frame reduces positive attitudes; (3) problematizing frames (i.e., Dualism body and mind and Non reciprocation) trigger negative emotions; (4) deproblematizing frames induce higher positive feelings, which increase positive attitudes.

CONCLUSIONS

Negative representations about AD reinforce the negative attitudes towards it. Reframing AD is essential to achieve a positive attitudinal change.

PRACTICE IMPLICATIONS

The use of deproblematizing frames (i.e., Unity of body and mind or Good Mother) should be considered when developing and implementing policies targeted at communication and awareness of AD to reduce the stigma associated with this disease.

Religious coping, care burden and psychological distress among informal caregivers of COVID-19 patients: Results of a cross-sectional survey in Pakistan

BACKGROUND

There is a complex relationship between health and religiosity. People may use religion to cope with difficulties and uncertainties in their life - such as induced by the COVID-19 pandemic.

AIMS

The purpose of this study is to investigate the relationship between religious coping, care burden and psychological distress among caregivers during COVID-19 in Pakistan.

METHOD

We conducted a cross-sectional survey in Pakistan. We used the Religious Coping Scale (RCOPE), Care Burden Scale (CB), and Depression, Anxiety and Stress Scale (DASS-21) to measure psychological stress from 303 caregivers. Data were analyzed using a hierarchical linear regression model for each of the three outcome variables, which are depression, anxiety, and stress. This analysis allows to investigate whether adding variables significantly improves a model's ability to predict the criterion variable.

RESULTS

The findings reveal that emotional care burden, physical care burden, negative religious coping, and social care burden explain a significant amount of the variance of three components of psychological distress among caregivers.

CONCLUSIONS

Health experts, psychologists, and policymakers can make better strategies to combat pandemics like COVID-19 by incorporating religious coping methods.

Emotion-focused dyadic coping styles used by family carers of people with dementia during the COVID-19 pandemic

Emotional wellbeing of family carers and people with dementia is associated with not only how each individual copes with stress and conflict, but also by how they cope together. Finding ways to positively cope together was particularly important during COVID-19 lockdown restrictions, when other avenues of emotional support were less available. We explored how carers experienced and used emotion-focused dyadic coping styles during the COVID-19 pandemic. In-depth qualitative interviews were conducted during the pandemic with 42 family carers, supplemented by quality of life scores collected both pre- and during the pandemic and household status. Abductive thematic analysis identified five styles of emotion-focused dyadic coping: common, supportive, hostile, disengaged avoidance and protective. The COVID-19 pandemic left many dyads unsupported. While many carers adapted, reporting increases in quality of life and enjoying the extra time with the person with dementia, others experienced dyadic conflict and reductions in quality of life. This variation was associated with dyadic coping styles, including challenges in using 'positive' styles and the protective use of 'negative' disengaged avoidance in the right situations. Dyadic coping styles also differed as a function of whether the dyad lived together. As many people with dementia are supported by an informal carer, considering how they cope together could help us to better support them. We make suggestions for dyadic interventions tailored by co-residency status that could help dyads identify and communicate coping needs, reconnect following avoidance coping, and replenish their coping resources through social support.

The early impacts of COVID-19 on unpaid carers of people living with dementia: part II of a mixed-methods systematic review

OBJECTIVES

With a lack of existing comprehensive reviews, the aim of this mixed-method systematic review was to synthesise the evidence on the early impacts of the pandemic on unpaid dementia carers across the globe.

METHODS

This review was registered on PROSPERO [CDR42021248050]. PubMed, CINAHL, Embase, Scopus and Web of Science were searched from 2020 to July 2021. Studies were included if they reported on the different impacts of the pandemic on unpaid dementia carers aged 18+, with papers published in English, German, Polish, or Spanish. A number of research team members were involved in the selection of studies following PRISMA guidance.

RESULTS

Thirty-six studies (43 papers) from 18 countries reported on the early impact of the pandemic on unpaid dementia carers. Impacts were noted on accessing care and support; carer burden; and well-being. Studies found that carers had limited access to care and support services, increased workload, enhanced feelings of social isolation, and reduced wellbeing. Specifically, reductions in access to care and support increased carer's unpaid caring tasks, removing any opportunities for temporary respite, and thus further increasing carer burden and reducing mental well-being in many.

CONCLUSIONS

The needs of unpaid dementia carers appear to have increased during the pandemic, without adequate support provided. Policy initiatives need to enable better mental health support and formal care provision for unpaid carers and their relatives with dementia, whilst future research needs to explore the long-term implications of carer needs in light of care home restrictions and care delivery.

Intergenerational family relationships and the impact of behavioural variant frontotemporal dementia (bvFTD): a qualitative longitudinal study

Research concerning the reciprocal influence of relationships and dementia largely focuses on dyadic relationships despite evidence that whole families are affected. Furthermore, such research generally considers more common forms of dementia such as Alzheimer's disease. Behavioural variant fronto-temporal dementia (bvFTD) primarily although not exclusively affects people below the age of 65 and is distinctly different in its impact from more common forms of dementia, affecting social cognition and therefore relational functioning. We aimed to develop a detailed understanding of intergenerational family experiences of bvFTD over time. We adopted a social constructivist and pluralist approach, using Narrative Thematic Analysis and Grounded Theory. We interviewed seven families in their own homes, including the person with bvFTD, at up to three time-points every six to nine months from 2012 to 2014, resulting in 46 interviews with 19 family members. Three super-ordinate themes were identified: Theme 1: We before bvFTD: cohesive and connected – disconnected and distant; Theme 2: Challenges experienced by us; and Theme 3: Relational outcomes: a changing we – an entrenched we. Results emphasise bvFTD brought early and significant disruption to family relationships. The interplay of prior relational functioning, involving the nature of the relationship for family members, the specific impact of bvFTD on these relationships and family member's understanding of bvFTD was critical to how each family fared over the duration of the research, and the relational outcomes they experienced. These findings suggest health-care practice could enhance its support for families living with bvFTD, through the development of tailored, family-oriented approaches to assessment and practice. Such approaches are necessary to understand how families work together and identify interventions that address the family-specific challenges bvFTD brings. The provision of tailored, relational-focused and specialised information concerning the experience of living with bvFTD is needed to flexibly address families' needs and expectations.

How Did the COVID-19 Restrictions Impact People Living With Dementia and Their Informal Carers Within Community and Residential Aged Care Settings in Australia? A Qualitative Study

The aim of this study was to explore how formal social support changed after implementation of the COVID-19 public health measures and how these restrictions affected people living with dementia and their informal carers in Australia. Sixteen informal carers and two people living with dementia were interviewed between August and November 2020. Participants were asked about their experiences of the pandemic and the impact that the restrictions had on their lives and care. Thematic analysis identified four overarching themes describing (a) prepandemic limitations of the aged care system, (b) the aged care system's response to the COVID-19 restrictions, (c) changes affecting informal carers, and (d) the challenges faced by people living with dementia. The findings highlighted the challenges faced by the Australian aged care system before the pandemic and the additional burden placed on informal carers who supported people living with dementia across residential and home settings during the pandemic.

A Comparison of Well-Being of Carers of People with Dementia and Their Ability to Manage Before and During the COVID-19 Pandemic: Findings from the IDEAL Study

BACKGROUND

Social restriction measures imposed to curb the spread of COVID-19 in the United Kingdom impacted on carers of people with dementia, limiting access to support services and increasing perceived burden of caring. Few studies have compared data collected both during and before the pandemic to examine the effect of these changes.

OBJECTIVE

To explore whether the COVID-19 pandemic affected the well-being of carers of people with dementia living in the community, and their ability to cope with their caring responsibilities.

METHODS

Analysis was conducted on two groups of carers who were enrolled in the IDEAL programme; the 'pre-pandemic group' (n = 312), assessed at two time points prior to the pandemic, and the 'pandemic group', assessed prior to and several months into the pandemic (n = 156). For the pre-pandemic group, carers were matched 2:1 to carers in the pandemic group on certain characteristics. Differences in change over time between the two groups on self-reported well-being, quality of life, coping, perceived competence, and role captivity, was investigated using mixed effect modelling.

RESULTS

Compared to the pre-pandemic group, those in the pandemic group appeared to cope better and had more stable self-rated competency and role captivity. They did not differ in terms of well-being or quality of life.

CONCLUSIONS

Despite reports of negative impacts on carers early in the pandemic, the findings suggest the pandemic had little negative longer-term impact on carers of people with dementia, and in fact they appeared to have a more positive attitude towards coping several months into the pandemic.

Impact of COVID-19 on carers of people with dementia in the community: Findings from the British IDEAL cohort

OBJECTIVE

Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data.

METHODS

Data were collected between September 2020 and April 2021 in England and Wales. Carers were identified from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort and data were collected either through the telephone, video conferencing, or an online questionnaire. Responses from 242 carers were compared against benchmark data from the IDEAL cohort collected pre-pandemic. Analyses were conducted for the full sample of carers and spousal/partner carers only.

RESULTS

In total 48.8% of carers thought their healthcare needs were negatively affected during the pandemic. Compared with pre-pandemic data carers were more lonely and experienced less life satisfaction. There was little impact on carers' experience of caregiving, although carers felt trapped in their caregiving role. Carers were more optimistic and had higher social contact with relatives. There were changes in the methods carers used for contacting relatives and friends. Most carers coped very or fairly well during the pandemic. There was little difference in the experiences of spousal/partner carers and the full sample.

CONCLUSIONS

After a long period of providing care under pandemic conditions carers require additional support. This support needs to be focused on alleviating feelings of loneliness and increasing life satisfaction. Services need to consider how to improve access to health care, particularly resuming face-to-face appointments.

Emotional Function, Negative Thoughts about the Pandemic, and Adaptability Skills among Dementia Caregivers during the COVID-19 Pandemic

Background: It can be easily inferred that dementia caregivers were severely affected by the general home confinement, or ‘lockdown’, due to their caregiving roles. Aim: The aim of the current study is to investigate how the quarantine measures applied during the COVID-19 pandemic affected the emotional function (specifically the emotional management, emotional experience, and stress symptoms) and the negative thoughts, as well as the adaptability skills, of Greek dementia caregivers. Materials andMethods: In total, 303 participants (138 in the non-caregiving adults-control group; 165 in the dementia caregivers-experimental group) were recruited from the day centers of the Greek Association of Alzheimer Disease and Related Disorders (GAADRD) from June 2020 to January 2021 in Thessaloniki, Greece. The caregiving population was split into group 1 (those who participated in support groups) and group 2 (those who did not participate in support groups). A self-reported questionnaire was created for research purposes and was digitally administered to participants via Google forms. Results: During the quarantine period, dementia caregivers had more difficulties in emotional management, especially in regards to stress symptoms, which was measured via the Beck Anxiety Inventory (BAI), in comparison to the control group. In regards to the caregiving populations, caregivers from group 1 were more able to manage their emotions according to their self-reports, but had increased agony and loneliness. Moreover, statistical significance was found between emotional management, negative feelings, and stress symptoms in those from group 2 who self-reported that the PwD deteriorated. This evidence was not found in group 1. Finally, there were no differences in the means of negative thoughts about the pandemic, as well as in the adaptation skills, both in dementia caregivers and in the control group, according to their self-reports. Discussion: It seems that different emotional aspects were affected in the dementia caregivers’ population, and, therefore, future psychotherapeutic interventions should focus on those most severely affected by the restrictive measures imposed.

“Del miedo a la resiliencia”. Estudio fenomenológico sobre el impacto de la pandemia por COVID-19 en cuidadoras de pacientes dependientes en hemodiálisis

Objetivo: profundizar en el conocimiento sobre las vivencias y el soporte percibido en cuidadoras primarias que atendieron a pacientes dependientes en tratamiento con hemodiálisis durante el periodo de pandemia por COVID-19 en la ciudad de Madrid. Material y Método: estudio transversal efectuado con diez cuidadoras primarias de pacientes en tratamiento de hemodiálisis que habían proporcionado cuidados durante el periodo de marzo 2020 a junio 2021. La recolección de los datos se realizó mediante entrevistas semiestructuradas a distancia hasta conseguir la saturación de las unidades de significado. Se realizó un análisis cualitativo fenomenológico mediante el método de siete pasos de Colaizzi. Resultados: del análisis de los discursos emergieron dimensiones asociadas a diferentes subcategorías: miedo inicial sobre la enfermedad, pérdida de libertad, riesgo percibido durante el transporte, soporte percibido por parte de los centros de diálisis, capacidad de resiliencia, miedo a la muerte e impacto de la vacunación. Conclusiones: en la etapa álgida del brote epidémico las vivencias de las cuidadoras estuvieron muy influidas por el desconocimiento de la enfermedad y el miedo al contagio. Adaptaron medidas de auto prevención para mantener a salvo a su familiar. Apreciaron la seguridad proporcionada por los profesionales de los centros. Les preocupaba los riesgos inherentes a los traslados y la falta de soporte de los servicios sociales. Son conscientes de su propia fragilidad y la de la persona cuidada y no perciben grandes cambios ni en su forma de vida ni en su esperanza de futuro, pese a la vacunación y otros adelantos científicos.