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Wu J, Wang M, Yan H. Web-based interventions on the resilience of informal caregivers: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:1-14. [PMID: 37676014 DOI: 10.1080/13548506.2023.2253510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
Informal caregivers play an increasingly important role in the provision of care services, especially for the ageing population. At present, the evidence on the resilience of the Internet to family caregivers is still limited. The purpose of this study was to evaluate the factors related to the resilience of the Internet to family caregivers. We searched retrieved randomized controlled trials (rct) of the effects of Internet interventions on resilience in informal caregivers from the beginning of the database to 1 November 2022. A preliminary search identified 3348 studies, 5 of which met the inclusion criteria. The studies involved 482 participants from four countries. Our results show that compared to the control group, internet intervention can effectively improve the resilience level of caregivers [SMD = 0.65, 95%CI(0.04,1.26), P ≤ 0.05]. In our study, Web-based interventions can significantly improve the adaptability of informal caregivers. In addition, our research also pointed out many resources that can be used, such as online learning, online answers and online psychological counseling provided for caregivers through the Internet, which can effectively reduce their burden of care and thus improve their resilience. In the future, these findings can be used to develop projects to improve the resilience of caregivers through personalized Internet intervention, so as to meet the care needs of patients.
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Affiliation(s)
- Jingwen Wu
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Min Wang
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hong Yan
- Department of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Wang W, Wang X, Vellone E, Zhang Z. Effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and caregivers: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e073016. [PMID: 37666544 PMCID: PMC10481751 DOI: 10.1136/bmjopen-2023-073016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION The promotion of self-care has begun to serve as a central response strategy to the rising burden of stroke. In fact, stroke self-care can be recognised to be a dyad phenomenon having an effect on the health of stroke survivors and their caregivers. While studies have confirmed the effectiveness of smartphone-based interventions in improving self-care among stroke survivors, there remains a lack of evidence specifically regarding dyadic self-care interventions for both patients and caregivers. AIM The present single-blinded, two-arm, randomised controlled trial aims to verify the effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and their caregivers. METHODS AND ANALYSIS The estimated sample size is 152 stroke survivor-caregiver dyads. The participants will be randomly classified (1:1) into either a control (N=76) or an experimental group (N=76) through block randomisation. The participants classified into the experimental group will be provided with SDSCP, and during the initial home visit, the research team members will provide instructions to all patients and caregivers on how to download and use the smartphone application. While the participants in the control group will be given the existing stroke standard care. The main outcome measures of stroke survivors will consist of the Self-Care of Stroke Inventory and a short version of the Stroke Specific Quality of Life Scale. The outcome measures of stroke caregivers will primarily cover the Caregiver Contribution to Self-Care of Stroke Inventory and Zarit burden interview. The data of this study will be collected at three time points, including baseline, 1 month and 6 months from the baseline. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Zhengzhou University (ZZUIRB 2021-115) in January 2021. The results achieved in this study will facilitate the clinical practice to improve self-care of stroke survivors and promote dyadic health outcomes for stroke patients and caregivers. TRIAL REGISTRATION NUMBER The study was registered with the Chinese Clinical Trial Registry and the registration number is ChiCTR2100053591.
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Affiliation(s)
- Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxuan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ercole Vellone
- Department of Biomedicine and Prevention, Universita degli Studi di Roma Tor Vergata, Roma, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Jiang N, Xv Y, Sun X, Feng L, Wang YB, Jiang XL. Study on self-management of real-time and individualized support in stroke patients based on resilience: a protocol for a randomized controlled trial. Trials 2023; 24:493. [PMID: 37537646 PMCID: PMC10401848 DOI: 10.1186/s13063-023-07475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The transitional period from hospital to home is vital for stroke patients, but it poses serious challenges. Good self-management ability can optimize disease outcomes. However, stroke patients in China have a low level of self-management ability during the transitional period, and a lack of effective support may be the reason. With the rapid development of technology, using wearable monitors to achieve real-time and individualized support may be the key to solving this problem. This study uses a randomized controlled trial design to assess the efficacy of using wearable technology to realize real-time and individualized self-management support in stroke patients' self-management behavior during the transitional period following discharge from hospital. METHODS This parallel-group randomized controlled trial will be conducted in two hospitals and patients' homes. A total of 183 adult stroke patients will be enrolled in the study and randomly assigned to three groups in a 1:1:1 ratio. The smartwatch intervention group (n = 61) will receive Real-time and Individualized Self-management Support (RISS) program + routine care, the wristband group (n = 61) will wear a fitness tracker (self-monitoring) + routine care, and the control group (n = 61) will receive routine stroke care. The intervention will last for 6 months. The primary outcomes are neurological function status, self-management behavior, quality of life, biochemical indicators, recurrence rate, and unplanned readmission rate. Secondary outcomes are resilience, patient activation, psychological status, and caregiver assessments. The analysis is intention-to-treat. The intervention effect will be evaluated at baseline (T0), 2 months after discharge (T1), 3 months after discharge (T2), and 6 months after discharge (T3). DISCUSSION The cloud platform designed in this study not only has the function of real-time recording but also can push timely solutions when patients have abnormal conditions, as well as early warnings or alarms. This study could also potentially help patients develop good self-management habits through resilience theory, wearable devices, and individualized problem-solution library of self-management which can lay the foundation for long-term maintenance and continuous improvement of good self-management behavior in the future. TRIAL REGISTRATION The ethics approval has been granted by the Ethics Committee of West China Hospital, Sichuan University (2022-941). All patients will be informed of the study details and sign a written informed consent form before enrollment. The research results will be reported in conferences and peer-reviewed publications. The trial registration number is ChiCTR2300070384 . Registered on 11 April 2023.
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Affiliation(s)
- N Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Y Xv
- Department of Surgical Anesthesiology, Tai'an City Central Hospital, Tai'an, China
| | - X Sun
- Department of Neurology, Tianjin Third Central Hospital, Tianjin, China
| | - L Feng
- Department of Neurology/West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Y B Wang
- Tai'an Tax Bureau, State Administration of Taxation, Tai'an, China
| | - X L Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Niu S, Ding S, Wu S, Ma J, Shi Y. Correlations between caregiver competence, burden and health-related quality of life among Chinese family caregivers of elderly adults with disabilities: a cross-sectional study using structural equations analysis. BMJ Open 2023; 13:e067296. [PMID: 36806142 PMCID: PMC9944642 DOI: 10.1136/bmjopen-2022-067296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To examine the relationship between caregiver competence and health-related quality of life (HRQoL) among family caregivers of disabled elderly adults, and to evaluate the role of caregiver burden as a potential mediator of that relationship. DESIGN Cross-sectional study. SETTING Two general hospitals in Shanghai, China. PARTICIPANTS Study participants were 135 family caregivers of disabled elderly adults listed on a roster for outpatient and emergency services utilisation from January to March 2022. DATA ANALYSIS AND OUTCOME MEASURES We used stratified linear regression and structural equation model analysis. HRQoL was the main outcome, measured using the Medical Outcomes Study 36-Item Short form Health Survey. Caregiver competence was assessed using the Family Caregiver Task Inventory, and caregiver burden was assessed with the Zarit Burden Interview. RESULTS Caregivers of moderately and severely disabled elderly adults showed poorer scores in Physical Component Summary (F=20.463, p<0.05) and Mental Component Summary (F=17.062, p<0.05) compared with caregivers of older adults with mild disabilities. At the same time, those caregivers showed higher scores on the caregiving burden (F=19.533, p<0.05) and caregiving difficulties (F=16.079, p<0.05). A structural equation model was performed and successfully adjusted (χ2/df=1.175, p=0.261, NFI=0.970, RFI=0.949, IFI=0.995, CFI=0.995, GFI=0.963, TLI=0.992, AGFI=0.920, RMSEA=0.036). The total effect of Family Caregiver Task Inventory scores on HRQoL scores was -0.980, with a direct effect of -0.645. The mediating effect on HRQoL scores through the intermediate variable of caregiver burden scores was -0.335. CONCLUSIONS Family caregivers' HRQoL is closely related to caregiver difficulties and burdens. Early identification and targeted measures are needed to reduce the burden and problems in caregiving.
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Affiliation(s)
- Shuzhen Niu
- Department of Nursing, Tenth People's hospital, School of Medicine, Tongji University, Shanghai, China
| | - Silian Ding
- Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Songqi Wu
- Department of Nursing, Tenth People's hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiajia Ma
- Department of Nursing, Tenth People's hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Shi
- Department of Nursing, Tenth People's hospital, School of Medicine, Tongji University, Shanghai, China
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Mikkola TM, Mänty M, Kautiainen H, von Bonsdorff MB, Koponen H, Kröger T, Eriksson JG. Use of prescription benzodiazepines and related drugs in family caregivers: a nation-wide register-based study. Age Ageing 2022; 51:6936400. [PMID: 36571780 PMCID: PMC9792078 DOI: 10.1093/ageing/afac279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND objective indicators of sleep and mental health problems in family caregivers have rarely been reported. OBJECTIVE to study the use of prescription benzodiazepines and related drugs (BZDRD) in Finnish family caregivers and matched controls. DESIGN prospective follow-up in 2012-17. SETTING nationwide register-linkage study. SUBJECTS all individuals who received family caregiver's allowance in Finland in 2012 (N = 42,256; mean age 67 years; 71% women) and controls matched for age, sex and municipality of residence (N = 83,618). METHODS information on purchases of prescription BZDRD, including the number of defined daily doses (DDDs), between 2012 and 2017 was obtained from the Dispensations Reimbursable under the National Health Insurance Scheme register. Background information was obtained from national registers. RESULTS more caregivers than controls used BZDRD, both among women (users per 100 person-years: 17.2 versus 15.2, P < 0.001) and men (14.6 versus 11.8, P < 0.001). These differences were largely explained by hypnotic BZDRD use. There were also more long-term BZDRD users per 100 person-years among caregivers than controls, both among women (5.0 versus 4.3, P = 0.001) and men (5.3 versus 3.8, P < 0.001). Use of hypnotic BZDRD in number of DDDs was higher in caregivers than in controls, particularly among men above 50 years. Caregivers used more anxiolytic BZDRD than controls from middle age to 75 years but less in the oldest age groups. CONCLUSIONS higher level of BZDRD use among caregivers indicates that caregivers have more sleep and mental health problems than non-caregivers. Adequate treatment of these problems and support for caregiving should be ensured for caregivers.
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Affiliation(s)
- Tuija M Mikkola
- Address correspondence to: Tuija M. Mikkola, Folkhälsan Research Center, PO Box 211, 00251 Helsinki, Finland.
| | - Minna Mänty
- Unit of Strategy and Research, City of Vantaa, Vantaa, Finland,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland,Gerontology Research Centre and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teppo Kröger
- Department of Social Sciences and Philosophy, University of Jyväskylä, Jyväskylä, Finland,Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore,Department of Obstetrics & Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
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Hoshino J, Tamakoshi K, Hori Y, Sakakibara H. Relationships Between Care Recipients’ Psychological Symptoms and Family Caregivers’ Depressive States. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211058814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aims to clarify the relationship between the number of behavioral and psychological symptoms in long-term care recipients and family caregivers’ depressive states. Participants were 38 family caregivers who had provided care for their relatives for 6 years or more; they were recruited from in-home care settings in Aichi, Gifu, and Shiga Prefectures, Japan. Participants answered a self-administered questionnaire assessing their depressive state using the Japanese version of the Center for Epidemiologic Studies for Depression Scale (CES-D). They also answered questions inquiring about behavioral and psychological symptoms of care recipients, including resistance to care, irritability, and feelings of persecution. Using CES-D scores, 11 participants were categorized as depressed and 27 as non-depressed. Depressive symptoms were significantly greater in those with more behavioral and psychological symptoms, following adjustment for confounding factors. The odds ratio of being in a depressive state was 9.43 higher for those with more than 4 behavioral and psychological symptoms compared to those with none, showing a distinct threshold for the influence of behavioral and psychological symptoms on depressive state. Knowing the number of behavioral and psychological symptoms of care recipients may help quickly identify depressed caregivers and alleviate depressive symptoms.
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Affiliation(s)
- Junko Hoshino
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoko Hori
- Happy-Net Association, Nagoya, Aichi, Japan
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O'Malley KA, Qualls SH. Validation of a Comprehensive Measure of the Family Caregiver Experience: The Caregiver Reaction Scale. Clin Gerontol 2022; 45:503-513. [PMID: 32573394 DOI: 10.1080/07317115.2020.1774455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The Caregiver Reaction Scale (CRS) is a multi-dimensional measure of the family caregiving experience that assesses role conflict, challenges, and positive aspects of caregiving. The CRS has been validated in a sample of older adult caregivers who sought counseling, but its validity and reliability in a broader population of caregivers had not been established. This study aimed to explore how well the CRS assesses the multiple dimensions of the caregiving experience in a sample of family caregivers who match the national profile of caregivers and to confirm the validity and structure of the subscales. METHODS Family caregivers (N = 452), age 18-89 (M = 48.56, SD = 17.15) were recruited online and completed the CRS and questionnaires of burden and positive aspects of caregiving. A confirmatory factor analysis (CFA) was conducted to confirm the underlying factor structure of the CRS, and convergent and discriminant validity was examined. RESULTS CFA supported the existing structure of the CRS; all subscales demonstrated very good internal consistency reliability (α ≤.88), convergent validity (r ≥.39), and discriminant validity (r ≤.12). CONCLUSIONS The CRS offers a valid and reliable assessment of the caregiving experience as evidenced by the convergent and discriminant validity of CRS subscales with well-validated measures of burden and positive aspects of caregiving. CLINICAL IMPLICATIONS The CRS assesses multiple dimensions of caregiving that can be used to better understand the caregiver's experience, guide clinical interventions and referrals, and identify caregiver strengths.
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Affiliation(s)
- Kelly A O'Malley
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sara H Qualls
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
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Tang S, Li L, Xue H, Cao S, Li C, Han K, Wang B. Caregiver burden and associated factors among primary caregivers of patients with ALS in home care: a cross-sectional survey study. BMJ Open 2021; 11:e050185. [PMID: 34588253 PMCID: PMC8480006 DOI: 10.1136/bmjopen-2021-050185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aims to understand the caregiver burden experienced by the primary caregivers of patients with amyotrophic lateral sclerosis (ALS), and to explore the factors influencing caregiver burden. DESIGN A cross-sectional survey design was used. SETTING This study was conducted with ALS inpatients and follow-up outpatients at the neurology department of a tertiary general hospital in Taiyuan, Shanxi, China and their caregivers. PARTICIPANTS Patients with ALS and their caregivers (N=120 pairs) participated in a face-to-face interview. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures included the Zarit Burden Interview scores and personal/role burden scores. There were no secondary outcomes. RESULTS Multiple linear and logistic regression analyses were performed to examine the factors influencing burden in ALS patient's caregivers. Multiple linear regression showed that caregivers with higher Anxiety Index (AI) experienced greater personal (β=0.089, p<0.001), role (β=0.065, p<0.001) and overall (β=0.200, p<0.001) burden. Logistic regression analysis showed that AI (p=0.025; OR 1.351, 95% CI 1.038 to 1.759) and disease knowledge level (p=0.033; OR 0.305, 95% CI 0.107 to 0.593) are the influencing factors of ALS load classification. CONCLUSIONS Higher AI scores were associated with greater caregiver burden. Caregiver burden of caregivers who had no knowledge of the patient's disease was 0.305 times that of those who had good knowledge. The level of disease knowledge and AI score can serve as key predictors of caregiver burden in ALS.
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Affiliation(s)
- Shan Tang
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Li Li
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongxia Xue
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Shuyan Cao
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Chao Li
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Kunjing Han
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Binquan Wang
- College of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
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A Tale of Two Solitudes: Loneliness and Anxiety of Family Caregivers Caring in Community Homes and Congregate Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910010. [PMID: 34639311 PMCID: PMC8508318 DOI: 10.3390/ijerph181910010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
We surveyed 604 family caregivers residing in the province of Alberta to better understand the impact of the COVID-19 pandemic on anxiety, loneliness, and care work. We assessed anxiety with the Six-Item State Anxiety Scale and loneliness with the DeJong-Gierveld Loneliness Scale. The COVID-19 pandemic created two contexts giving rise to feelings of solitude for family caregivers. Family caregivers of Albertans living in private community homes were overwhelmed with caregiving needs while those caring for Albertans living in congregate settings were restricted from caregiving. The results indicated that before the COVID-19 pandemic, 31.7% of family caregivers were anxious and 53.5% were lonely. The proportions of those who were anxious rose to 78.8% and lonely to 85.9% during the pandemic. The qualitative responses of family caregivers connected being overwhelmed with care work either in community homes or as the designated essential caregiver in congregate living settings, as well as being unable to care in congregate care settings, with anxiety and loneliness. The caregivers reporting improvements in their health and relationships with care-receivers credited spending time with the receiver doing pleasant activities together, rather than purely performing onerous care tasks. Policymakers need to consider organizing health and community services to ensure family caregivers are not overwhelmed with care tasks or excluded from caring in congregate care.
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Xu J, Liu PJ, Beach S. Multiple Caregivers, Many Minds: Family Discord and Caregiver Outcomes. THE GERONTOLOGIST 2021; 61:661-669. [PMID: 32539097 DOI: 10.1093/geront/gnaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Family caregivers often have other family members helping to provide care. The purpose of our study was to examine relationships between care coordination quality among family members and the following caregiver outcomes: caregiver mental health (depressive symptoms, anxiety), social activity restrictions, and caregiver burden. RESEARCH DESIGN AND METHODS Secondary analysis was conducted using data from the 2017 Pittsburgh Regional Caregivers' Survey. Six hundred and fifty-five caregivers who had other family members helping with care reported discordance in care coordination, depressive symptoms, anxiety, social activity restrictions, caregiving burden, and covariates such as demographics and known risk factors for negative caregiver outcomes. We used multiple logistic regression and negative binominal expansion models in the analysis. RESULTS Discordant care coordination was associated with higher levels of caregiver depressive symptoms (p < .001), anxiety (p < .01), social activity restriction (p < .001), and caregiver burden (p < .001) after controlling for known risk factors. DISCUSSION AND IMPLICATIONS We found that lower quality of family care coordination was associated with negative caregiver outcomes. Future research should further investigate the dynamics of family care coordination and impacts on both caregivers and care recipients. The results suggest that caregiver interventions attempting to understand and decrease care coordination discord should be a priority.
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Affiliation(s)
- Jiayun Xu
- School of Nursing and Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Pi-Ju Liu
- Center for Families, Purdue University, West Lafayette, Indiana
| | - Scott Beach
- University Center for Social & Urban Research, University of Pittsburgh, Pennsylvania
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11
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Rojas-Ocaña MJ, Araujo-Hernández M, Romero-Castillo R, García Navarro EB. Educational interventions by nurses in caregivers with their elderly patients at home. Prim Health Care Res Dev 2021; 22:e26. [PMID: 34092277 PMCID: PMC8220347 DOI: 10.1017/s1463423621000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The home is the natural setting for the development of informal care. The work that nurses are required to develop in this context (the carer/the elderly dependent/the home) focuses on training and educational activities to assist these two groups, such as demonstrating care activities to help dependent seniors, instruction in self-care techniques and teaching strategies for the use of human and material resources. AIMS This article analyzes care education interventions performed by nurses, and the factors that facilitate, or limit, health care training. METHODOLOGICAL APPROACH This is a qualitative, descriptive study designed to be flexible and openly analytical in its approach to the research problem and the dynamic nature of the home environment. Triangulation of the methodological techniques and study subjects was applied. RESULTS Nursing interventions related to professional attitudes, such as encouraging communication and facilitating teaching; communication interventions in health education and counseling; and technical interventions aimed at improving access to health information and support for the informal carer. Lack of will, the advanced age of the carer, emotional state and work overload are factors that undermine care instruction, which if reversed, would become learning facilitators. The lack of time and resources in the home are the major limiting factors on care teaching, according to nurses. Evidence from our study suggests that care in the home is considered a key primary health care strategy, one in which nurses play a significant role.
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12
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Boerner K, Kim YK, Gallagher EA, Kim K, Jopp DS. "I'm Getting Older Too": Challenges and Benefits Experienced by Very Old Parents and Their Children. J Appl Gerontol 2021; 41:769-779. [PMID: 34027691 DOI: 10.1177/07334648211016113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Very old parents and their "old" children are a growing group in industrialized countries worldwide. However, virtually nothing is known about the nature and implications of this relationship constellation. To fill this gap, this study explored the challenges and rewards of the very old parent-child relationship. In-depth interviews were conducted with 114 parent-child dyads (parent age ≥90; child age ≥65). While both challenges and rewards were present, the balance of challenges and rewards was notably less favorable for children with more challenges experienced overall. Challenges reported by children were often characterized by references to children's own advanced age and health problems, and the prolonged caregiving involvement due to their parents' longevity. Health care professionals, policymakers, and families should be made aware of this increasingly common phenomenon, and specific services and policies will be needed to adequately support very old adults and their families.
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Affiliation(s)
| | | | | | | | - Daniela S Jopp
- University of Lausanne/Swiss National Centre of Competence in Research LIVES, Switzerland
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13
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Campione JR, Zebrak KA. Predictors of Unmet Need Among Informal Caregivers. J Gerontol B Psychol Sci Soc Sci 2021; 75:2181-2192. [PMID: 31907540 DOI: 10.1093/geronb/gbz165] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions. METHODS Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded "Definitely No" to the question "Are you receiving all the help you need?" were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden. RESULTS Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school. DISCUSSION Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.
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Affiliation(s)
- Joanne R Campione
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
| | - Katarzyna A Zebrak
- Department of Healthcare Delivery Research and Evaluation, Westat, Inc., Rockville, Maryland
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Abstract
OBJECTIVES Demonstrations of the effectiveness of interventions requires evidence that the model can be implemented with fidelity. Caregiving interventions that are tailored to the individual or family require flexibility, which adds some challenges to the assessment of fidelity. This paper outlines the components necessary for examining treatment fidelity and common barriers to implementing fidelity studies, offers considerations for designing fidelity studies with tailored caregiver interventions, and aims to provide a set of procedures that can be used to guide future fidelity studies. METHOD Case study methods are used to illustrate the processes and findings, drawing on two research studies of fidelity in tailored caregiver interventions. RESULTS Fidelity studies consist of core components (i.e. training on intervention delivery, adherence to the intervention, therapist competence, acceptability and outcomes) that should be maintained and monitored throughout the study to elucidate the relationship between the intervention and outcomes. These components are applicable to tailored caregiver interventions and can be implemented with the consideration of some key issues that are addressed prior to the evaluation. The two cases presented utilized similar methods to evaluate fidelity of two different tailored caregiver interventions. CONCLUSION Treatment fidelity can be assessed for tailored caregiving interventions, which increases confidence about the potency of the active ingredients in the interventions. Standard fidelity guidelines can be implemented with minor additional considerations.
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Affiliation(s)
| | - Sara H Qualls
- University of Colorado at Colorado Springs, Colorado Springs, CO, USA
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15
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Teixeira MJC, Abreu W, Costa N, Maddocks M. Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal. BMC Palliat Care 2020; 19:73. [PMID: 32450848 PMCID: PMC7249372 DOI: 10.1186/s12904-020-00583-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time. Methods An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data. Results Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time. Conclusions These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.
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Affiliation(s)
- Maria João Cardoso Teixeira
- Royal National Orthopaedic Hospital NHS Foundation Trust & National Institute for Health Research (NIHR), Brockley Hill Road, Stanmore, Middlesex, HA7 4LP, UK.
| | - Wilson Abreu
- School of Nursing & Research Centre "Centre for Health Technology and Services Research / ESEP -CINTESIS", Porto, Portugal
| | - Nilza Costa
- University of Aveiro - Research Centre "Didactic and Technology in the Education of Educators/CIDTFF", Aveiro, Portugal
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College of London, London, UK
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16
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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Voutilainen A, Ruokostenpohja N, Välimäki T. Associations Across Caregiver and Care Recipient Symptoms: Self-Organizing Map and Meta-analysis. THE GERONTOLOGIST 2018; 58:e138-e149. [PMID: 28329837 DOI: 10.1093/geront/gnw251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose of the Study The main objective of this study was to reveal generalizable associations across caregiver burden (CGB), caregiver depression (CGD), care recipient cognitive ability (CRCA), and care recipient behavioral and psychological symptoms of dementia (BPSD). Design and Methods Studies published between 2004 and 2014 and reporting CGB and/or CGD together with CRCA and/or BPSD were included. Only 95 out of 1,955 studies provided enough data for data clustering with the Self-Organizing Map (SOM) and 27 of them for meta-analyses based on correlation coefficients. Results Caregiver and care recipient symptoms were not tightly associated with each other, except for the CGB-BPSD interaction at the individual level. SOM emphasized the cluster comprising studies reporting low CGB, low CGD, high CRCA, and few BPSD. Meta-analyses indicated high heterogeneity between the original studies. Implications Relationships between caregiver and care recipient symptoms should be treated as situation-specific phenomena, at least when the symptoms are moderate at most. Dementia caregiving per se should not be understood as a source of stress and mental health problems. More systematic and coherent use of measures is necessary to enable a comprehensive analysis of caregiving.
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Affiliation(s)
- Ari Voutilainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Nora Ruokostenpohja
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Lynch SH, Shuster G, Lobo ML. The family caregiver experience - examining the positive and negative aspects of compassion satisfaction and compassion fatigue as caregiving outcomes. Aging Ment Health 2018; 22:1424-1431. [PMID: 28812375 DOI: 10.1080/13607863.2017.1364344] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Caregiving results in both positive and negative outcomes for caregivers. The purpose of this study was to examine compassion fatigue and compassion satisfaction in family caregivers. METHODS Using a cross sectional descriptive survey design with a convenience sample, 168 family caregivers of individuals with chronic illness completed a web-based survey. Measures included a demographic questionnaire, Caregiver Burden Interview, Brief COPE inventory and Professional Quality of Life (ProQOL). RESULTS The majority of participants (71%) reported high levels of caregiver burden, moderate to low levels of the compassion fatigue concepts of burnout (59.5%) and secondary traumatic stress (STS) (50%), and moderate levels of compassion satisfaction (82.7%). Regression analyses showed that caregiver burden, time caregiving, coping, social support, and caregiving demands explained a total variance of 57.1%, F(11,119) = 14.398, p < .00 in burnout and a total variance of 56%, F(11, 119) = 13.64, p < .00 in STS. Specifically, behavioral disengagement is a predicator that may indicate early compassion fatigue. CONCLUSION Findings suggest that despite high caregiver burden and moderate compassion fatigue, family caregivers are able to provide care and find satisfaction in the role. This study supports the use of compassion fatigue and compassion satisfaction as alternative or additional outcomes to consider in future research.
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Affiliation(s)
- Susan H Lynch
- a School of Nursing , University of North Carolina Charlotte , Charlotte , NC , USA
| | - Geoff Shuster
- b College of Nursing , University of New Mexico , Albuquerque , NM , USA
| | - Marie L Lobo
- b College of Nursing , University of New Mexico , Albuquerque , NM , USA
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19
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Bunn F, Goodman C, Jones PR, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. Managing diabetes in people with dementia: a realist review. Health Technol Assess 2018; 21:1-140. [PMID: 29235986 DOI: 10.3310/hta21750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. DESIGN Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. PARTICIPANTS Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. DATA SOURCES The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). RESULTS We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. LIMITATIONS There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. CONCLUSIONS This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020625. FUNDING The NIHR HTA programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | - Antony Bayer
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Chris Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
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20
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Abstract
OBJECTIVES Research on caregiving interventions has increased substantially in recent years. Although many promising approaches have been tested, results are often modest. The goal of this paper is to identify conceptual and methodological issues that could lead to better treatment outcome. METHOD A critical review of the literature on interventions for caregivers of persons with dementia. RESULTS A fundamental issue in caregiver interventions is what are appropriate goals for treatment and what outcome measures should be used to address those goals. There also needs to be more testing of the mechanisms by which treatment leads to improvement. Intervention studies should also more regularly examine fidelity of treatment implementation. CONCLUSION Recommendations are made for improving the design of future trials through better attention to the heterogeneity of the caregiving population, improved conceptualization of goals and the use of innovative designs that accommodate differences in caregivers' needs and resources.
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Affiliation(s)
- Steven H Zarit
- a Department of Human Development and Family Studies (Emeritus) , The Pennsylvania State University , University Park , PA , USA
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21
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The Role of Adult Day Services in Supporting the Occupational Participation of People with Dementia and Their Carers: An Integrative Review. Healthcare (Basel) 2018; 6:healthcare6020043. [PMID: 29738489 PMCID: PMC6023311 DOI: 10.3390/healthcare6020043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/03/2022] Open
Abstract
The increasing numbers of people with dementia places considerable stress on health and aged care services and has resulted in the development of community adult day services. Aim: The aim of this integrative review is to determine the extent to which these services support the occupational participation of people with dementia, and how they impact their primary carers. Method: The mixed-methods appraisal tool (MMAT) was used to identify relevant studies in the period 2011–2016. Results: Nine databases were searched and yielded 16 articles with a variety of research designs for inclusion in the review. Conclusions: Findings indicate that adult day services use a range of approaches to support attendees and their carers. In spite of these efforts, there appears to be a lack of interest in utilizing these services while a person is in the early stages of dementia. This suggests that policies in aged care, such as aging-in-place, need to consider the pressure and stress they exert on carer’s quality of life. Another consideration is to better promote the benefits of participating in adult day services in the early stages of dementia for both the attendees and their carers, thereby delaying the tendency towards early institutionalization.
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22
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Liu HY, Huang LH. The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator. Aging Ment Health 2018; 22:558-567. [PMID: 28001431 DOI: 10.1080/13607863.2016.1269148] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to explore caregiving self-efficacy as a mediator for the association between family functioning and caregiving appraisal of dementia family caregivers in Taiwan. METHOD This study adopted a cross-sectional correlational design. Purposive sampling was used to recruit 115 dyads of dementia patients and family caregivers from the outpatient neurological clinics of two hospitals in northern Taiwan. Data were gathered through interviews with a structured questionnaire, which included demographic characteristics for caregivers and patients, family functioning, caregiving self-efficacy, as well as positive and negative aspects of caregiving appraisal. RESULTS Family functioning, patients' activities of daily living score, Neuropsychiatric Inventory caregiver distress, and three domains of self-efficacy were significantly associated with caregiver burden. Hierarchical multiple regression analyses indicated that self-efficacy for obtaining respite (SE-OR) significantly explained 20.5% of the variance in caregiver esteem. Caregiver perceived worsened health status, family functioning, and SE-OR significantly explained 59% of the variance in caregiver burden. The mediation test only supported the partially mediating role of SE-OR on the relationship between family functioning and caregiver burden, while the mediating effect of self-efficacy for responding to disruptive behaviours and controlling upsetting thoughts were insignificant. CONCLUSION Our findings provided preliminary evidence for health professionals recommending that future studies should assess the family dynamic and health problems of caregivers, and develop appropriate family-centred interventions that focus on strengthening interfamily support and respite services to alleviate caregiver burden.
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Affiliation(s)
- Hsin-Yi Liu
- a Department of Nursing , College of Medicine, National Taiwan University , Taipei , Taiwan.,b Department of Nursing , Jen-Teh Junior College of Medicine, Nursing and Management , Miaoli , Taiwan
| | - Lian-Hua Huang
- a Department of Nursing , College of Medicine, National Taiwan University , Taipei , Taiwan
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23
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Bunn F, Goodman C, Reece Jones P, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. What works for whom in the management of diabetes in people living with dementia: a realist review. BMC Med 2017; 15:141. [PMID: 28750628 PMCID: PMC5532771 DOI: 10.1186/s12916-017-0909-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/04/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. METHODS This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders - user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers - took part in interviews, and 24 participated in a consensus conference. RESULTS We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. CONCLUSIONS Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. TRIAL REGISTRATION PROSPERO, CRD42015020625. Registered on 18 May 2015.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, LU1 3UA, UK
| | - Antony Bayer
- Division of Population Medicine, Cardiff University, Cardiff, Wales, CF10 3AT, LL57 2EF, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK
| | | | - Christopher Burton
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
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Abstract
OBJECTIVE Reliable and valid measures of caregiver experience are critical components of researching the caregiver experience and providing effective care to family caregivers. Assessments should be comprehensive, including positive aspects of caregiving as well as multiple dimensions of stress and burden (Family Caregiver Alliance, 2006). One such measure is the Caregiver Reaction Scale (CRS), a clinical tool adapted from research protocols in 1990. METHODS This study is a preliminary examination of the psychometric properties of the CRS using a sample of family caregivers (N = 502) seeking services at a community based mental health and aging family service agency. RESULTS The eight subscales of the CRS exhibited very good internal reliability α ≥ .81. Test-retest reliability was r ≥ .62, and convergent validity evidence is positive. Means and standard deviations are reported. CONCLUSIONS Initial psychometrics suggest the CRS offers a reliable and valid assessment of multiple dimensions of the caregiving experience and warrants further research.
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Affiliation(s)
- Kelly A O'Malley
- a University of Colorado Colorado Springs , Colorado Springs , Colorado , USA
| | - Sara H Qualls
- a University of Colorado Colorado Springs , Colorado Springs , Colorado , USA
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25
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Heid AR, Zarit SH, Fingerman KL. Adult Children's Responses to Parent "Stubbornness". THE GERONTOLOGIST 2017; 57:429-440. [PMID: 26873033 DOI: 10.1093/geront/gnv691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/12/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study People cope with relationship tensions in different ways. One such tension that is frequently reported is how adult children respond to conflicts with their aging parents when they see their parents as insisting, resisting, or persisting in their behaviors-acting in ways commonly attributed to stubbornness. Design and Methods Middle-aged adults (N = 383) completed measures regarding their parents' stubbornness, their responses to that stubbornness, depressive symptoms, positive and negative relationship quality, and support they provide their parents. Multiple regression and multilevel models were utilized to examine whether middle-aged offspring's responses to perceived parent stubbornness were associated with the offspring's reported depressive symptoms, positive and negative relationship quality, and provision of support. Results Adult children most frequently endorsed responding to parents' "stubborn" behaviors by "just letting their requests go." Results revealed associations of adult children's response strategies with their reports of depressive symptoms (more letting go), positive relationship quality (less letting go and more reasoning), negative relationship quality (more arguing, more rewording their request, and less reasoning), and the amount of support they provide to their parents (more arguing, more reasoning, and more waiting to address the concern another day). Implications Adult children's responses to perceived parent stubbornness are linked to individual and relationship functioning, as well as the support the children provide. Interventions to develop adaptive responses when there are differences in goals may prove useful for families.
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Affiliation(s)
- Allison R Heid
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| | - Steven H Zarit
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park
| | - Karen L Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin
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26
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Pérez-Fuentes MDC, Gázquez Linares JJ, Ruiz Fernández MD, Molero Jurado MDM. Inventory of Overburden in Alzheimer's Patient Family Caregivers with no Specialized Training. Int J Clin Health Psychol 2017; 17:56-64. [PMID: 30487881 PMCID: PMC6236318 DOI: 10.1016/j.ijchp.2016.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background/Objective: Alzheimer-type dementia is one of the most frequent causes of dependence in an aging population, which combines with a considerable demand for care. Furthermore, when the caregiver is a family member or person without specialized training, such care impacts on that person's health. The Inventory of Overburden in Alzheimer's Patient Family Caregivers with no Specialized Training (IPSO-CA24) was designed to find out the needs of these caregivers and evaluate the caregiver's burden or distress. Method: The psychometric properties of the questionnaire were analyzed (in a reliability analysis, exploratory factor analysis and confirmatory analysis) based on the responses of 255 caregivers. Results: The factor analyses showed a six-factor structure (Reaction to diagnosis, Physical health, Psychological symptomatology (caretaker), Behavioral symptomatology (patient), Knowledge of the illness, and Level of dependence) explaining 66.52% of the total variance with a reliability of .75 to .93. Support was also found for its convergent validity. Conclusions: The IPSO-CA24 responds to the need for an instrument enabling multidimensional evaluation of the burden on the family caregiver without specialized training.
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Kiriake A, Moriyama M. Development and Testing of the Partnership Scale for Primary Family Caregivers Caring for Patients With Dementia. JOURNAL OF FAMILY NURSING 2016; 22:339-367. [PMID: 27406824 DOI: 10.1177/1074840716656450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article reports the development and preliminary testing of a new scale named "Partnership Scale for Primary Family Caregivers Caring for Patients With Dementia" that measures the ability of primary family caregivers to establish partnerships while providing care for patients with dementia in Japan. The first draft of the scale was developed using qualitative data from interviews with five primary family caregivers; a pool of 39 items was created through a review process with dementia care experts and researchers. An exploratory factor analysis and confirmatory factor analysis were conducted with data from 261 primary family caregivers who completed the instrument. This resulted in a multidimensional scale that consists of three factors with 13 items. The suitability of the model and intraclass correlation coefficient (ICC) values (1, 1) obtained by the test-retest method satisfied statistical standards. The criterion-related validity of the scale was significantly correlated to an external reference, which was the desired outcome. However, some subscales exhibited low internal consistency, demonstrating the need for further research.
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Millenaar JK, de Vugt ME, Bakker C, van Vliet D, Pijnenburg YAL, Koopmans RTCM, Verhey FRJ. The Impact of Young Onset Dementia on Informal Caregivers Compared with Late Onset Dementia: Results from the NeedYD Study. Am J Geriatr Psychiatry 2016; 24:467-74. [PMID: 26560507 DOI: 10.1016/j.jagp.2015.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/23/2015] [Accepted: 07/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The impact of the dementia might be more severe for caregivers of people with young onset dementia (YOD) compared with those who care for someone with late onset dementia (LOD), as a young age among caregivers has been identified as a predictor of increased burden. The present study compares well-being between LOD and YOD caregivers longitudinally because this knowledge is essential in order to develop adequate support programs. DESIGN, SETTING, AND PARTICIPANTS 220 YOD and 108 LOD patient-caregiver dyads were included from two prospective cohorts with a 2-year follow up. To assess well-being we used the Short Sense of Competence Questionnaire, the RAND-36, the Symptom Checklist 90, and the Montgomery Asberg Depression Rating Scale. The severity and the course of the different measures used to describe caregiver burden were analyzed with linear mixed models. RESULTS Caregivers in both groups experienced high levels of physical and psychological complaints, mild depressive symptoms, lower health-related quality of life (HRQoL), and decreased feelings of competence. The severity and the course of most measures were similar in both groups, although HRQoL on both the physical and the mental domain was lower for the YOD caregivers. CONCLUSIONS The number of actual psychological and physical complaints does not differ between YOD and LOD caregivers. YOD caregivers have greater perceived difficulties in daily life because of these complaints, however.
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Affiliation(s)
- Joany K Millenaar
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christian Bakker
- Florence Mariahoeve Center for Specialized Care in Young-Onset Dementia, Den Haag, the Netherlands; Department of Primary and Community Care: Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Deliane van Vliet
- Alzheimer Center Nijmegen, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Centre and Department of Neurology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care: Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, the Netherlands; Alzheimer Center Nijmegen, Radboud University Medical Center, Nijmegen, the Netherlands; Joachim en Anna Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
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Heid AR, Zarit SH, Van Haitsma K. Older adults' influence in family care: how do daughters and aging parents navigate differences in care goals? Aging Ment Health 2016; 20:46-55. [PMID: 26018736 DOI: 10.1080/13607863.2015.1049117] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study seeks to address how older adults influence their daily care when their preferences conflict with those of their adult daughter caregivers. METHOD Using a sample of 10 dyads (N = 20) of an older adult and adult daughter, we utilize content analysis strategies to analyze in-depth, semi-structured interview data with QSR NVIVO to investigate how older adults influence their care, how daughters respond to such efforts of influence, and how dyads navigate differences in care goals. RESULTS When there is agreement in goals, dyads report tasks going well and both individuals' requests are honored. When there are differences in care goals, daughters most frequently reason with their older parents, while parents walk away or 'let go' of their requests. Daughters report making decisions for their parents for health or safety-related needs. However, all dyads discuss differences in care goals, whereby parents are perceived as insisting, resisting, or persisting in care. CONCLUSION Findings illustrate complex patterns of responses by families when navigating differences in daily care goals that carry important implications for research and the development of dyadic-based family interventions.
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Affiliation(s)
- Allison R Heid
- a New Jersey Institute for Successful Aging , Rowan University School of Osteopathic Medicine , Stratford , NJ , USA.,b Department of Human Development and Family Studies , The Pennsylvania State University , University Park , PA , USA
| | - Steven H Zarit
- b Department of Human Development and Family Studies , The Pennsylvania State University , University Park , PA , USA
| | - Kimberly Van Haitsma
- c College of Nursing , The Pennsylvania State University , University Park , PA , USA.,d The Polisher Research Institute , The Madlyn and Leonard Abramson Center for Jewish Life , North Wales , PA , USA
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Panyavin I, Trujillo MA, Peralta SV, Stolfi ME, Morelli E, Perrin PB, Lasa JP, Arango-Lasprilla JC. Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina. Am J Alzheimers Dis Other Demen 2015; 30:613-21. [PMID: 25824253 PMCID: PMC10852719 DOI: 10.1177/1533317515577129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs). METHOD One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision. RESULTS Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care. CONCLUSION Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.
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Affiliation(s)
- Ivan Panyavin
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Michael A Trujillo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Eliana Morelli
- Instituto de Neurociencias de San Lucas, Rosario, Argentina
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Javier Peña Lasa
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain
| | - Juan Carlos Arango-Lasprilla
- Department of Methods and Experimental Psychology, University of Deusto, Bilbao, Spain Ikerbasque, Basque Foundations for Science, Bilbao, Spain
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Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study. Int Psychogeriatr 2014; 26:1211-20. [PMID: 24655686 DOI: 10.1017/s1041610214000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimer's disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change. METHODS Both AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models. RESULTS The mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers' depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregiver's depression was not taken into account in the analysis, female gender, and higher age and AD patient's lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change. CONCLUSIONS SOC is not as stable as expected, but decreases during long-lasting caregiving. Caregiver's depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.
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Hyer L, Scott C, Lyles J, Dhabliwala J, McKenzie L. Memory intervention: the value of a clinical holistic program for older adults with memory impairments. Aging Ment Health 2014; 18:169-78. [PMID: 23889364 DOI: 10.1080/13607863.2013.819832] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Increasingly, cognitive training appears an asset in improving attention and working memory for older adults. We conducted a study involving a 'holistic' training program for several cohorts of older adults (N = 112), targeting community residents with a spectrum of memory complaints ranging from Age Associated Memory Impairment to mild dementia. METHOD We developed a 7-session, manualized program targeting concentration, as well as mindfulness, exercise, stress reduction, socialization, diet, and values/identity techniques. We applied this model to 11 cohorts and conducted pre- and post-testing on memory (List Learning, Story Memory, Coding, Digit Span, Recall, and Recognition) and function (Functional Assessment Questionnaire). We also divided the Memory Group by Risk Status - Low, Medium, and High. RESULTS Results showed that the Memory Clinic Group as a whole improved on this training on most scales. When broken down by risk status, the Low and Medium Risk Groups were statistically superior to the High Risk Group on cognitive measures. CONCLUSION There were differences also on adjustment, this time favoring only the Low Risk Groups. Holistic memory training seems to be impactful for older adults.
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Affiliation(s)
- Lee Hyer
- a Georgia Neurosurgical Institute , Macon , GA , USA
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Pallant JF, Reid C. Measuring the positive and negative aspects of the caring role in community versus aged care setting. Australas J Ageing 2013; 33:244-9. [DOI: 10.1111/ajag.12046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julie F Pallant
- Rural Health Academic Centre; University of Melbourne; Shepparton Victoria Australia
| | - Carol Reid
- Carer Support Services; Family Care; Rural Health Academic Centre; University of Melbourne; Shepparton Victoria Australia
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Landmark BT, Aasgaard HS, Fagerström L. “To Be stuck in It—I Can’t Just Leave”. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822313487984] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The large number of individuals affected by dementia entails major challenges for home health care (HHC) and dementia-affected families. The aim of the study was to explore and describe relatives’ experiences of people with dementia living at home and to reveal the relatives’ needs for support. Focus group interviews (10 people) were used for data collection. The analysis was qualitative content analysis. The results show that relatives are unable to escape the situation and that the dignity of the person with dementia is threatened. Relatives experience a sense of powerlessness due to fragmented services. The continuity of HHC services constitutes a major challenge. Personnel should focus more on ethical considerations and on dialogue between formal and informal caregivers.
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Affiliation(s)
- Bjørg T. Landmark
- Buskerud University College, Drammen, Norway
- Institute of Research and Development for Nursing and Care Services, Drammen, Norway
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Predictors and outcomes for caregivers of people with mild cognitive impairment: A systematic literature review. Alzheimers Dement 2013; 9:346-55. [DOI: 10.1016/j.jalz.2012.01.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/13/2012] [Indexed: 11/18/2022]
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Adaptation and analysis of psychometric features of the Caregiver Risk Screen: a tool for detecting the risk of burden in family caregivers. Int Psychogeriatr 2013; 25:755-64. [PMID: 23388522 DOI: 10.1017/s1041610212002426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are a limited number of scales available in the Spanish language that can be used to detect burden among individuals who care for a dependent family member. The purpose of this work was to adapt and validate the Caregiver Risk Screen (CRS) scale developed by Guberman et al. (2001) (Guberman, N., Keefe, J., Fancey, P., Nahmiash, D. and Barylak, L. (2001). Development of Screening and Assessment Tools for Family Caregivers: Final Report. Montreal, Canada: Health Transition Fund). METHODS The sample was made up of 302 informal caregivers of dependent family members (average age 57.3 years, and 78.9% were women). Scale structure was subjected to a confirmatory factor analysis. Concurrent and convergent validity were assessed by correlation with validated questionnaires for measuring burden (Zarit Burden Inventory (ZBI)) and psychological health (SCL-90-R). RESULTS The results show a high level of internal consistency (Cronbach's alpha = 0.86), suitable fit of the one-dimensional model tested via confirmatory factor analysis (GFI = 0.91; CFI = 0.91; RMSEA = 0.097), and appropriate convergent validity with similar constructs (r = 0.77 with ZBI; and r-values between 0.45 and 0.63 with SCL-90-R dimensions). CONCLUSIONS The findings are promising in terms of their adaptation of the CRS to Spanish, and the results enable us to draw the conclusion that the CRS is a suitable tool for assessing and detecting strain in family caregivers. Nevertheless, new research is required that explores all the psychometric features on the scale.
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Zarit SH, Lee JE, Barrineau MJ, Whitlatch CJ, Femia EE. Fidelity and acceptability of an adaptive intervention for caregivers: an exploratory study. Aging Ment Health 2013; 17:197-206. [PMID: 22943746 PMCID: PMC3570581 DOI: 10.1080/13607863.2012.717252] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE There has been growing interest in providing tailored or adaptive interventions to family caregivers as a way of addressing their heterogeneity of risk factors and other needs. A particular challenge in an adaptive study is to implement the individualized intervention protocol as planned (program fidelity). This study explores the fidelity of implementation of an adaptive intervention for family caregivers of persons with dementia and its acceptability to caregivers. METHOD Using a sample of 35 caregivers of person with dementia who participated in a program development study, we gathered information on acceptability and fidelity of the program from multiple sources, including caregiver and counselor reports and ratings of recordings of sessions. RESULTS Findings show that caregivers have high levels of acceptance of the intervention plan and high ratings of satisfaction with the program. Ratings of satisfaction and counselor competence were not associated with the amount of treatment provided. Ratings by counselors and independent raters found good fidelity for two of the three program domains. DISCUSSION The results demonstrate that trained counselors can follow a tailored intervention plan and that caregivers' experience of the program did not differ depending on how much intervention was provided. A next step is to determine how an adaptive protocol would affect caregiver outcomes.
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Affiliation(s)
- Steven H. Zarit
- Department of Human Development and Family Studies, Penn State University, University Park, PA, USA,Corresponding author:
| | - Jeong Eun Lee
- Department of Human Development and Family Studies, Penn State University, University Park, PA, USA
| | - Mary Jon Barrineau
- Department of Human Development and Family Studies, Penn State University, University Park, PA, USA
| | - Carol J. Whitlatch
- Margaret Blenkner Research Institute, Benjamin Rose Institute on Aging, Cleveland, OH 44120
| | - Elia E. Femia
- Department of Human Development and Family Studies, Penn State University, University Park, PA, USA
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Yang X, Hao Y, George SM, Wang L. Factors associated with health-related quality of life among Chinese caregivers of the older adults living in the community: a cross-sectional study. Health Qual Life Outcomes 2012. [PMID: 23186128 PMCID: PMC3541082 DOI: 10.1186/1477-7525-10-143] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Under the culture of filial piety and due to the Confucianism spirit in China, family caregivers usually undertake the responsibilities of caring for the older adults. They usually suffer from a heavy burden which is believed to impair their mental and physical health. Thus this study aims to describe the health-related quality of life (HRQOL) among Chinese caregivers of the older adults living in the community and explore the predictors of caregivers’ HRQOL. Methods A cross-sectional study was conducted through convenience sampling. The study population was composed of 1,144 caregivers of older adults who suffered from one or more types of chronic diseases in 15 communities in 3 eastern cities of China. Family caregivers were interviewed face-to-face using the 36-item Short-Form Health Survey (SF-36) and the ZARIT Caregiver Burden interview (ZBI) scales. The Antonovsky's Sense of coherence (SOC) scale was also used to measure personal coping capability of the caregivers. Hierarchical multiple regression analysis (HMR) was performed to explore the predictors of caregivers’ HRQOL. Results The majority of the caregivers were females (60.0%) or adult children (66.5%). Mental QOL was significantly lower than physical QOL. Hierarchical multiple regression analysis showed that Demographic Characteristics of Caregivers, Patients’ Characteristics, and Subjective Caregiver Burden explained most of the total variance of all aspects of HRQOL. While, Objective Caregiving Tasks was only associated with physical QOL. Subjective Caregiver Burden was the strongest predictor of both physical and mental QOL. SOC was also a strong predictor of physical and mental QOL. Conclusions The mental QOL of the caregivers of older adults was disrupted more seriously than physical QOL. Additionally, Subjective Caregiver Burden might decrease caregiver’ health. A decrease in caregiver burden could promote better management of caregiving tasks, and improve HRQOL. Also, coping capabilities, like SOC, are needed to decrease the impact of caregiving on HRQOL of Chinese caregivers of the older adults.
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Affiliation(s)
- Xiaoshi Yang
- Department of Social Medicine, School of public health, China medical university, No,92 North second road, Heping District, Shenyang, 110001, China
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Dementia knowledge and attitudes of the general public in Northern Ireland: an analysis of national survey data. Int Psychogeriatr 2012; 24:1600-13. [PMID: 22591515 DOI: 10.1017/s1041610212000658] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND This paper provides an overview of the findings from the dementia module of the 2010 Northern Ireland Life and Times (NILT) Survey: an annual survey recording public attitudes to major social policy issues. Northern Ireland, in line with many other developed countries, recently released a Dementia Strategy. The opportunity to explore the knowledge and attitudes of the general public to dementia at a national level in Northern Ireland is timely and valuable. This paper reports on an initial exploration of these attitudes, based on bivariate analysis across demographic groups. METHODS Data were analyzed using SPSS (Version 19). Descriptive and summary statistics were produced. A series of categorical bivariate relationships were tested (chi-square) and tests of association (Cramer's V) were reported. We discuss both knowledge-related findings and attitudinal findings. RESULTS We found that the general public in Northern Ireland have a reasonably good level of knowledge about dementia. However, attitudinal measures indicate the stereotyping and infantilization of people with dementia. CONCLUSIONS This NILT module provides a unique source of data on attitudes to, and knowledge of, dementia. A key strength is that it provides statistically representative data with national level coverage. This information can be used to target public health education policies more effectively and to inform delivery of health and social services. The success of the module leads us to believe that it stands as a blue-print for collecting information on dementia in other social surveys.
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Yeh PM, Chang Y. Family carer reactions and their related factors among Taiwanese with hospitalized relatives. J Adv Nurs 2011; 68:2195-206. [PMID: 22128763 DOI: 10.1111/j.1365-2648.2011.05904.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to examine the relationships among family carer reactions and their related factors among Taiwanese with hospitalized relatives. BACKGROUND In Taiwan, most hospitalized patients have relatives or foreign labourers with them 24 hours a day. Limited research has focused on the reactions of family members who provide care for hospitalized relatives. METHODS A cross-sectional, correlation design was used. A convenience sample of 200 primary carers of hospitalized patients diagnosed with cancer, stroke, and enduring illness was recruited between 2009 and 2010. Data were collected by structured questionnaires. RESULTS The findings indicate that participants with a moderate level of family support experienced a moderate impact on health and finances, but a high impact on schedule. Family carers' health status and work time were significantly different between, before and after serving as a carer. The multiple regression model variables accounted for 40.1% of the total family carer reaction variance. Three factors were found to predict significantly greater impact on a family carer: (1) lower scores of caregiving knowledge, (2) increasing patient's activities of daily living dependency and (3) lack of family support. CONCLUSION It is vital for nurses not only to assess patients' activities of daily living, but also to assess family carers' knowledge of caregiving and the patient's existing family support in developing a plan of care that reduces negative impact on family carers.
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Affiliation(s)
- Pi-Ming Yeh
- Department of Nursing, Missouri Western State University, St. Joseph, Missouri, USA.
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Hodgins MJ, Wuest J, Malcolm J. Modeling the effects of past relationship and obligation on changes in the health and health promotion of women caregivers of family members with dementia. Res Nurs Health 2011; 34:440-56. [PMID: 22045437 DOI: 10.1002/nur.20454] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2011] [Indexed: 11/08/2022]
Abstract
Wuest's (1998, 2001) caregiving theory was tested with 282 women self-identified as caregivers of family members with dementia to examine how quality of past relationship within caregiving dyads and sense of obligation to care affected their health outcomes and health promotion over 9 months, using latent growth curve analysis. The model explained 62% of the variance in women's health (Time 4). Health was affected positively by past relationship and negatively by obligation. Health promotion was positively affected by health (Time 1) and by obligation. Change observed in health promotion was nonlinear and positively affected health (Time 4). Findings suggest past relationship and obligation to care predict health outcomes for caregivers and that interventions to increase caregivers' health promotion may improve health outcomes.
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Affiliation(s)
- Marilyn J Hodgins
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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Yeh PM, Bull M. Use of the resiliency model of family stress, adjustment and adaptation in the analysis of family caregiver reaction among families of older people with congestive heart failure. Int J Older People Nurs 2011; 7:117-26. [DOI: 10.1111/j.1748-3743.2011.00275.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reamy AM, Kim K, Zarit SH, Whitlatch CJ. Understanding discrepancy in perceptions of values: individuals with mild to moderate dementia and their family caregivers. THE GERONTOLOGIST 2011; 51:473-83. [PMID: 21383111 DOI: 10.1093/geront/gnr010] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY We explore discrepancies in perceptions of values and care preferences between individuals with dementia (IWDs) and their family caregivers. DESIGN AND METHODS We interviewed 266 dyads consisting of an individual with mild to moderate dementia and his or her family caregiver to determine IWDs' beliefs for 5 values related to care (autonomy, burden, control, family, and safety). We used multilevel modeling to investigate if there are dyadic level discrepancies in beliefs and what factors are associated with such discrepancies. RESULTS Caregivers consistently underestimated the IWD's values for all five values. Discrepancies were associated primarily with caregivers' beliefs about the IWD's involvement in decision making. Race was also associated with the discrepancies for control and safety, whereas cognitive functioning of the IWD was associated with the discrepancy for burden. IMPLICATIONS Many caregivers do not have an accurate depiction of the IWD's values, yet, caregivers will become the surrogate decision makers for IWDs as dementia progresses. These findings indicate the need for assessments of values and preferences in care and to develop programs that assess values, consider the caregiver's beliefs about care, and improve communication within the dyad in the early stages of dementia.
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Affiliation(s)
- Allison M Reamy
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA 16802, USA.
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Wiprzycka UJ, Mackenzie CS, Khatri N, Cheng JW. Feasibility of Recruiting Spouses With DSM-IV Diagnoses for Caregiver Interventions. J Gerontol B Psychol Sci Soc Sci 2011; 66:302-6. [DOI: 10.1093/geronb/gbr004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Negovanska V, Hergueta T, Guichart-Gomez E, Dubois B, Sarazin M, Bungener C. Bénéfice d’un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d’Alzheimer sur l’anxiété du conjoint : étude française ELMMA. Rev Neurol (Paris) 2011; 167:114-22. [DOI: 10.1016/j.neurol.2010.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/03/2010] [Accepted: 07/07/2010] [Indexed: 11/28/2022]
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