Older Caregivers: Who They Are and How to Support Them

Caregiving responsibility and psychological distress among community-dwelling cancer survivors in the United States

PURPOSE

There are over 18 million cancer survivors in the U.S., with a projected increase of 24.4% over the next decade. Currently, little is known about the relationship between a cancer survivor's caregiving responsibility and their psychological distress. This study examines whether cancer survivors who assume the role of informal caregivers (surviving caregivers) experience greater psychological distress than cancer survivors without caregiving responsibilities.

METHODS

Data were drawn from the National Cancer Institute's Health Information National Trends Survey (HINTS5, Cycles 1 through 4, 2017-2020). The analytical sample included 2,579 U.S. cancer survivors. Caregiving responsibility was self-reported, and psychological distress was assessed through the Patient Health Questionnaire-4 (PHQ-4). Accounting for the complex design features of HINTS and jackknife replicate weights, a multivariable multinomial logistic regression model was fit to compute adjusted odds ratios (aORs) and their associated 95% confidence intervals (CIs).

RESULTS

Overall, 19.3% of cancer survivors had mild psychological distress, and 10.9% had moderate to severe psychological distress. Approximately 19.1% of the cancer survivors self-reported caregiving responsibilities. Compared to cancer survivors with no caregiving responsibilities, surviving caregivers had more than twofold greater odds of experiencing mild (aOR = 2.25; 95% CI: 1.17, 4.29) and moderate to severe (aOR = 2.18; 95% CI: 1.07, 4.46) psychological distress. Other factors associated with greater psychological distress among cancer survivors included female sex, lower perceived health status, and having one or more chronic diseases.

CONCLUSIONS

Our findings indicate that caregiving among cancer survivors has a substantial adverse impact on their mental and emotional well-being. Cancer surviving caregivers are a distinct subgroup that navigates both survivorship and caregiving burdens at the same time. There is a need to identify and develop tailored interventions, programs, and resources for this vulnerable group of cancer survivors.

Loneliness Among Older Caregivers: An Analysis of the 2020 California Health Interview Survey

Aging and caregiving are each risk factors for loneliness, but little is known about loneliness among older caregivers. Using the 2020 California Health Interview Survey (N = 7638), this study examined the relationship between (1) caregiving status and loneliness among older adults; (2) sociodemographic, technology, health, and caregiving characteristics and loneliness among older caregivers; and (3) compared how these variables relate to loneliness among older caregivers of persons with dementia versus non-dementia conditions. Findings revealed that 15% of older caregivers experienced loneliness, with dementia caregiving significantly increasing this likelihood. Immigrant caregivers, frequent internet users, and those with poorer self-reported health were at higher risk of experiencing loneliness. Future interventions, such as online social programs that foster social engagement, must be thoughtfully designed to align with the unique situations of older caregivers.

Physical and Mental Health of Informal Carers from Culturally and Linguistically Diverse (CALD) and Non-CALD Groups in Australia

INTRODUCTION

Empirical evidence shows that many family carers, especially immigrants, experience considerable health disadvantages and poorer quality of life. Australia has a rapidly increasing multicultural population, officially referred to as Culturally and Linguistically Diverse (CALD) people. This paper explores similarities and differences in the carer profile and physical and mental health of CALD and non-CALD family carers.

METHODS

A cross-sectional anonymous survey was conducted of self-reported family carers aged 18 years and older. Identical paper and online survey modes were provided to enable choice. Key variables included demographic and carer profile, diagnosed chronic physical health conditions, and validated scales such as CESD-12 and MOS-SF12, including derivative composite Physical and Mental Component Summary (PCS and MCS, respectively) scores. The sample comprised 649 participants (CALD = 347, non-CALD = 302). The analyses included univariate, bivariate, and multivariable linear regression analyses for three outcome variables: PCS, MCS, and CESD-12.

RESULTS

CALD carers were comparatively younger and married, and 54% had university-level education (29% in the gfvnon-CALD group). Women were primary carers in both groups (67.4% versus 72.2%). The weekly care hours were higher for non-CALD carers. Both groups had below population-referenced scores for mean PCS and MCS values. For CESD-12, non-CALD respondents had higher scores (17.5 vs. 11.2, p < 0.022). Regression analyses showed significant differences for demographic, carer, and physical health variables across the three outcome variables.

DISCUSSION AND CONCLUSION

Women have a higher domestic workload, which, when combined with high care hours, adversely impacts physical and mental health. The need for improved and culturally aligned care support systems is required.

The State of Family Caregiving Policy

As the population ages and supportive services are increasingly delivered in home- and community-based settings, greater demands are placed on family caregivers. This essay introducing the special issue of the Journal of Aging and Social Policy discusses signs of progress on policies to ease the burden on family caregivers. It introduces a series of articles that reflect the growing body of research on caregiver-related policy actions. These actions range from expanding access to paid family leave and payment for providing care, to ensuring access to better data about family caregivers and improving the post- hospital discharge experiences of rural and underserved caregivers. It also explores a major conundrum around caregiving policy - why progress on family caregiving policy has been so slow, despite its clear importance to the health and welfare of those who receive supports, as well as to those providing supports. In addition, the essay discusses developments, such as Biden administration actions and the RAISE Family Caregiver Advisory Council, indicating that the political dynamic around caregiving has changed, concluding that this is a uniquely hopeful time for family caregiver-related policy.

Promoting Spiritual Coping of Family Caregivers of an Adult Relative with Severe Mental Illness: Development and Test of a Nursing Intervention

Severe mental illness disrupts daily functioning, burdening family caregivers, who often adopt spiritual coping strategies. With comprehensive skills, mental health nurses can promote well-being and mental health. The aim is to develop and test the nursing intervention "promoting spiritual coping" in the family caregivers of home-dwelling people with mental illness. This study was conducted in two distinct stages. Initially, the intervention was developed according to the first phase of the Framework for Developing and Evaluating Complex Interventions. Secondly, the intervention protocol was tested in a mixed-method pilot study. An intervention protocol was developed and tested on ten family caregivers. The intervention comprised three sessions, and before-and-after assessments were conducted. Significant improvements were observed in the outcomes, with caregivers expressing that discussing spirituality and religiosity benefited them. This intervention prioritized the therapeutic relationship of the nurses and family caregivers. The intervention "promoting spiritual coping" was created and evaluated as a suitable approach for mental health nurses to use in a psychotherapeutic context with family caregivers of individuals with mental illness.

Addressing the workforce crisis in (rural) social care: A scoping review

BACKGROUND

This scoping review identifies strategies potentially addressing the 'workforce crisis' in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.

METHODS

The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.

RESULTS

The most common strategies for addressing social care workforce shortages were to improve recruitment and retention ('recruit and retain') processes without materially changing the workforce composition or service models. Further strategies involved 'revitalising' the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved 're-thinking' social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.

CONCLUSION

The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.