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Cejalvo E, Gisbert-Pérez J, Martí-Vilar M, Badenes-Ribera L. Systematic review following COSMIN guidelines: Short forms of Zarit Burden Interview. Geriatr Nurs 2024; 59:278-295. [PMID: 39094351 DOI: 10.1016/j.gerinurse.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
This comprehensive review assessed the psychometric properties of abbreviated versions of the Caregiver Burden Instrument (ZBI-22). Initially, 40 articles that met the inclusion criteria were identified through a systematic search of four databases. Additionally, 26 articles were included through manual searches, totaling 66 articles in the analysis. Different versions of instruments measuring caregiver burden were examined, considering item variability and differences in factor structures. Although most measures exhibited satisfactory content validity, as well as construct validity supported by high internal consistencies, it is important to note that measurement invariance, criterion validity and test-retest reliability were not established for all measures analyzed. Furthermore, structural validity was not satisfactory for all versions. Research and clinical practice could benefit from a standardized approach that allows for a more accurate and consistent assessment of caregiver strain.
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Affiliation(s)
- Elena Cejalvo
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Spain
| | - Julia Gisbert-Pérez
- Department of Behavioural Sciences Methodology, Faculty of Psychology and Speech Therapy, Universitat de València, Spain
| | - Manuel Martí-Vilar
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Spain.
| | - Laura Badenes-Ribera
- Department of Behavioural Sciences Methodology, Faculty of Psychology and Speech Therapy, Universitat de València, Spain
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Li H, Wong CL, Jin X, Wang N, Shi Z. Effects of acceptance and commitment therapy on fatigue interference in patients with advanced lung cancer and caregiving burden: protocol for a pilot randomised controlled trial. BMJ Open 2024; 14:e082090. [PMID: 39043593 PMCID: PMC11268034 DOI: 10.1136/bmjopen-2023-082090] [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: 11/14/2023] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Cancer-related fatigue is common in patients with advanced lung cancer. It not only interferes with patients' health-related quality of life, but also increases the caregiving burden of their caregivers. Acceptance and commitment therapy is emerging as a novel way to advocate accepting negative experiences and taking effective actions based on their own values to help patients commit meaningful actions in the course of cancer diseases. This trial aims to test the feasibility, acceptability and preliminary effects of acceptance and commitment therapy for fatigue interference in patients with advanced lung cancer and the caregiver burden. METHOD AND ANALYSIS A two-arm, assessor-blind pilot randomised controlled trial will be conducted. A total of 40 advanced lung cancer patient-caregiver dyads, who live in rural areas, will be recruited from a university-affiliated hospital in central China. The participants will be randomised to receive an online six-session acceptance and commitment therapy (i.e. involving metaphors, experiential exercises and mindfulness exercises facilitated by virtual reality technology) plus health education (intervention group, n=20) or health education (control group, n=20). Outcomes will be measured at baseline and 1 week postintervention. The primary outcomes are study feasibility (i.e. eligibility rate, recruitment rate, attrition rate and adherence rate), fatigue interference and caregiver burden. The secondary outcomes are health-related quality of life, meaning in life, psychological flexibility and mindful attention. Semistructured interviews will be conducted to explore the feasibility and experiences of the intervention in a subsample of 10 participants from the intervention group. ETHICS AND DISSEMINATION This study has been approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No. 2023.030) and the Medical Ethics Committee of Xiangya Hospital Central South University (No. 202305336). The findings will be disseminated in peer-reviewed journals and through local or international conference presentations. TRIAL REGISTRATION NUMBER NCT05885984.
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Affiliation(s)
- Huiyuan Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China
| | - Xiaohuan Jin
- The School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Nina Wang
- Respiratory Department, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zhengkun Shi
- Respiratory Department, Xiangya Hospital Central South University, Changsha, Hunan, China
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Kwok JYY, Cheung DSK, Zarit S, Cheung KSL, Lau BHP, Lou VW, Cheng ST, Gallagher-Thompson D, Chou KL. Multiphase optimization of a multicomponent intervention for informal dementia caregivers: a study protocol. Trials 2023; 24:791. [PMID: 38053147 DOI: 10.1186/s13063-023-07801-3] [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: 08/17/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Family caregiver interventions are essential to support dementia caregiving. However, such interventions are typically complex and consist of multiple components. Existing evidence rarely delineates the effectiveness and interactions between individual components. To optimise intervention, we adopt the multiphase optimisation strategy (MOST) to test the implementation fidelity and determine the effect of each component and the interactions between each component and the corresponding outcome. METHODS A prospective, assessor-blinded, randomised clinical trial with fractional factorial design using the MOST principle. Two hundred fifty family dementia caregivers will be randomised to one of 16 experimental conditions in a fractional factorial design involving six intervention components: (1) dementia and caregiving education; (2) self-care skills; (3) behavioural symptom management; (4) behavioural activation; (5) modified mindfulness-based cognitive therapy; and (6) support group. The first one is the core component, and the five remaining will be examined. Physical health, caregiver burden, stress, psychological well-being, anxiety and depressive symptoms, and social support will be assessed over the 12-month study period. Following the intention-to-treat principle, linear mixed models and regression analyses will be used to examine the specific effect of the five components and their two-way interactions to propose the most effective combination. DISCUSSION This is the first study adopting the multiphase optimisation strategy to identify the most active and engaging components of a psychological intervention for caregivers of patients with dementia. In view that dementia caregiver interventions are increasingly diversified and complex, such knowledge is important to maximise the intervention efficacy and allow the intervention to be implemented within an efficient timeframe and dosage. The optimisation of caregiver support interventions is critical to enhance the health outcomes of caregivers and care recipients, thereby, delaying possible institutionalisation and reducing the costs of long-term dementia care. TRIAL REGISTRATION This study was retrospectively registered in the WHO Primary Registry - Chinese Clinical Trials Registry (ChiCTR2300071235). (Protocol date 30/10/2020; version identifier 2020-2021-0045). Registered on 9 May, 2023. REPORTING METHOD SPIRIT guideline was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong SAR.
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Steven Zarit
- Human Development & Family Studies, Penn State University, University Park, USA
| | - Karen Siu-Lan Cheung
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
- WHO Collaborating Centre (WHO CC), School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- Asia-Pacific Institute of Ageing Studies (APIAS), Lingnan University, Tuen Mun, Hong Kong SAR
| | - Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong SAR
| | - Vivian Weiqun Lou
- Sau Po Centre On Ageing, University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong SAR
| | | | - Kee-Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Tai Po, Hong Kong SAR
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Li KK, Leung CLK, Yeung D, Chiu MYL, Chong AML, Lam BCY, Chung EKH, Lo TW. Development and validation of the caregiver needs and resources assessment. Front Psychol 2023; 14:1063440. [PMID: 37008844 PMCID: PMC10064064 DOI: 10.3389/fpsyg.2023.1063440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
IntroductionExisting caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes.MethodsItems of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA.ResultsThe results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity.DiscussionThe CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.
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Affiliation(s)
- Kin-Kit Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- *Correspondence: Kin-Kit Li,
| | - Cyrus L. K. Leung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Cyrus L. K. Leung,
| | - Dannii Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Marcus Y. L. Chiu
- School of Health and Wellbeing, University of Bolton, Bolton, United Kingdom
- Centre for Mental Health and Society, Bangor University, Bangor, United Kingdom
| | - Alice M. L. Chong
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Beck C. Y. Lam
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Edwin K. H. Chung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - T. Wing Lo
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
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Yeung CCY, Ho KHM, Chan HYL. A dyadic advance care planning intervention for people with early-stage dementia and their family caregivers in a community care setting: a feasibility trial. BMC Geriatr 2023; 23:115. [PMID: 36859250 PMCID: PMC9979490 DOI: 10.1186/s12877-023-03815-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is highly relevant for people with early-stage dementia to communicate their care preferences for serious illness conditions with their family caregivers before they become mentally incapacitated. METHODS A multi-centre, quasi-experimental study was conducted to test the feasibility and acceptability of a theory-guided, dyadic ACP intervention ('Have a Say' programme) among participants with early-stage dementia-family caregiver dyads. The feasibility of the trial design, intervention procedures, subject recruitment and retention, and study instruments were assessed. Study outcomes were measured at baseline (T0), immediately after the intervention (T1), and at 1 month (T2) and 3 months post-intervention (T3). Acceptability of the intervention was determined by the satisfaction score, completion rate and qualitative interviews as process evaluation with a purposive sample of participants and ACP facilitators. Generalised estimating equations were performed to examine differential changes between groups over time, with covariates adjusted. RESULTS Subject recruitment from five elderly community centres yielded a recruitment rate of 60% and resulted in 36 client-caregiver dyads. The intervention was acceptable to the dyads, with a mean satisfaction score of 4.4 out of 5 and completion rate of 94.4%. The attrition rates at T1, T2, and T3 were 8.3%, 13.9%, and 19.4%, respectively. The intervention group reported a significantly greater improvement in the readiness for ACP at T1, self-efficacy for ACP at T3, and dyadic concordance on end-of-life care preferences at all time points than the control group, but not on depressive symptoms. Family caregivers in the intervention group reported a significantly higher caregiving burden at T2 than the control group. The qualitative findings revealed that triadic involvement of and trusting relationships among the dyads and ACP facilitators, and documentation of clients' views are the programme strengths, while the structured format and discussion about medical issues posed implementation challenges. CONCLUSIONS This ACP intervention and trial design were feasible and acceptable to the dyads. Several refinements were identified, including adding a nurse-led group-based session for information giving, allowing flexibility in arrangement, and adding measure of ACP engagement of family caregivers. A rigorous trial to test the effects of the ACP intervention is warranted. TRIAL REGISTRATION Retrospectively registered on 14/08/2020 at clinicaltrials.gov (Identifier: NCT04513106).
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Affiliation(s)
- Cheryl Chi-Yan Yeung
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Ken Hok-Man Ho
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, Hong Kong SAR, China.
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Development and Validation of a Multidimensional Short Version Zarit Burden Interview (ZBI-9) for Caregivers of Persons With Cognitive Impairment. Alzheimer Dis Assoc Disord 2023; 37:59-65. [PMID: 36706328 PMCID: PMC9946168 DOI: 10.1097/wad.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/27/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is a lack of appreciation of the full dimensionality of the original 22-item Zarit Burden Interview (ZBI) in the development of short versions. Existing short versions are premised upon a 1-factor or 2-factor structure or statistical techniques for item selection. Thus, there is a need for ZBI short versions that considers the multidimensional constructs of role strain, personal strain, and worry about performance (WaP) during item selection to provide a more holistic and comprehensive evaluation. PURPOSE To develop and validate a short version of ZBI through a combined quantitative and qualitative approach that incorporates the validated 4-factor structure of role strain demands; role strain-control; personal strain, and WaP. PATIENTS We studied 202 caregivers of patients with dementia (84.2%) or mild cognitive impairment (15.8%) attending a memory clinic in Singapore. METHODS Confirmatory factor analysis and qualitative considerations from expert consensus were used for item selection. Confirmatory factor analysis fit statistics support the 4-factor structure. The 9-item ZBI-9 showed good internal consistency (Cronbach's α=0.87) and convergent validity with anxiety and depression (Pearson correlation: Hospital Anxiety and Depression sub-scales, r≥0.56, P <0.001; ZBI- 22, r=0.95, P <0.001). Using a cut-off score of ≥13, ZBI-9 displayed good discriminatory ability for depressive symptoms (area under curve=0.79, P <0.001; sensitivity=70%, specificity=75%). The ZBI-9 also displayed comparable performance to the 22-item full version and three 12-item short versions. CONCLUSION The ZBI-9 is a multidimensional short-version assessment tool for caregivers of persons with dementia and mild cognitive impairment that is reliable, valid, and discriminates depressive symptoms.
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Lou VW, Cheng CYM, Yu DSF, Wong DFK, Lai DWL, Chong AML, Chen S, Chou KL. Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15711. [PMID: 36497785 PMCID: PMC9736359 DOI: 10.3390/ijerph192315711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.
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Affiliation(s)
- Vivian Weiqun Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Clio Yuen Man Cheng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Doris Sau Fung Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Daniel Fu Keung Wong
- Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, China
| | - Daniel W. L. Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, China
| | - Alice Ming Lin Chong
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong, China
| | - Shuangzhou Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Kee Lee Chou
- Department of Asian and Policy Studies, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong, China
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Cheng ST. Two sides of the same coin? Revisiting the relationship between burden and positive aspects of caregiving in dementia. Int J Geriatr Psychiatry 2022; 37. [PMID: 35861261 DOI: 10.1002/gps.5786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Studies have shown that items on the Zarit Burden Interview (ZBI) purported to measure self-criticism do not correlate well with the other items. Examination of item content suggests they may be measuring mixed sentiments-both positive and negative-about caregiving. This study examined whether self-criticism is related to positive aspects of caregiving (PAC) in a way that is different from caregiver strain, and if so, which types of PAC. METHODS/DESIGN The baseline data of two Alzheimer caregiver intervention studies were merged (N = 225). Based on previous factor analysis, 2 ZBI items formed the self-criticism measure while 16 ZBI items measured global strain. PAC was assessed by coding caregivers' narratives about positive gains into seven themes (relationship gains, growth, insights, competence/mastery, purpose, emotional rewards, and miscellaneous). RESULTS Global strain was mildly associated with fewer total PAC, in a way consistent with the literature, and with less competence/mastery. However, self-criticism was associated with stronger relationship gains and purpose. Younger caregivers reported more relationship gains but less emotional rewards. Longer caregiving duration was associated with more growth, but the reverse was true for chronic illnesses. Additionally, relationship closeness was associated with more emotional rewards, whereas care-recipient neuropsychiatric symptoms and functional impairment were associated with fewer relationship gains and emotional rewards respectively. CONCLUSION Thinking one is not doing enough may indicate feelings of inadequacy/guilt but may also signal devotion to the relative and a sense of purpose in the caregiving role. Analyzing total burden and PAC scores may obscure the relationships between their components.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, Hong Kong
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Leung AYM, Cheung T, Fong TKH, Zhao IY, Kabir ZN. The Use of an Electronic Painting Platform by Family Caregivers of Persons with Dementia: A Feasibility and Acceptability Study. Healthcare (Basel) 2022; 10:healthcare10050870. [PMID: 35628007 PMCID: PMC9141057 DOI: 10.3390/healthcare10050870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
Painting is a well-known method for alleviating stress, but it is uncertain whether family caregivers can use an electronic painting platform at home for this purpose. Aim. The aim in this study was to assess the feasibility and acceptability of having family caregivers of persons with dementia (FCPWD) draw electronic paintings using a mobile app, and to assess the preliminary effect of the intervention on their well-being. Methods. This was a two-phase feasibility and acceptability study, with qualitative interviews conducted in Phase 1 and qualitative interviews and a quantitative survey conducted in Phase 2. Caregiving burden, depressive symptoms, self-rated health, and social support were measured before and after the intervention. Participants were asked to draw electronic paintings at any time they liked, and to share the paintings with friends or relatives if they wished. Result. The recruitment rate in Phase 2 was 87.5% (28 out of 32), with 78.6% participants (22 out 28) completing all activities in 8 weeks. The FCPWD regarded the e-painting app as an appropriate channel for expressing their emotions. They found the layout of the app to be easy to use and were satisfied with it. A total of 116 pictures were produced. Log-in frequency was significantly correlated with the sharing of paintings with friends or relatives (r = 0.72, p < 0.001). Conclusion. FCPWD considered the e-painting mobile app to be a feasible and acceptable technology-based psychosocial platform. A further investigation with a larger sample in a full-scale randomized controlled trial is warranted.
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Affiliation(s)
- Angela Y. M. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (T.C.); (I.Y.Z.)
- WHO Collaborating Centre for Community Health Services (WHOCC), The Hong Kong Polytechnic University, Hong Kong 999077, China
- Centre for Gerontological Nursing (CGN), The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Correspondence: ; Tel.: +852-2766-5587
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (T.C.); (I.Y.Z.)
| | - Tommy K. H. Fong
- Centre for Gerontological Nursing (CGN), The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Department of Psychiatry, The University of Hong Kong, Hong Kong 999077, China
| | - Ivy Y. Zhao
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (T.C.); (I.Y.Z.)
- WHO Collaborating Centre for Community Health Services (WHOCC), The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Zarina N. Kabir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14183 Stockholm, Sweden;
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Boluarte-Carbajal A, Paredes-Angeles R, Tafur-Mendoza AA. Psychometric Properties of the Zarit Burden Interview in Informal Caregivers of Persons With Intellectual Disabilities. Front Psychol 2022; 13:792805. [PMID: 35356334 PMCID: PMC8959923 DOI: 10.3389/fpsyg.2022.792805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Intellectual disability leads to a loss of autonomy and a high level of dependence, requiring support from another person permanently. Therefore, it is necessary to incorporate the assessment of caregiver burden in healthcare actions, to avoid putting the health of caregivers and patients at risk. In this sense, the study aimed to analyze the internal structure of the Zarit Burden Interview (ZBI) in a sample of caregivers of people with intellectual disabilities, to provide convergent and discriminant evidence with a measure of the risk of maltreatment, and to estimate the reliability of the scores from the Classical Test Theory and the Rasch Measurement Theory. The study was instrumental. The sample consisted of 287 Peruvian informal primary caregivers of persons diagnosed with intellectual disabilities. To collect validity evidence, the internal structure (confirmatory factor analysis, CFA) and the relationship with other variables (convergent and discriminant evidence) were used, while reliability was estimated through the omega coefficient and Rasch analysis. The internal structure of the ZBI corroborated a unidimensional structure. In terms of convergent and discriminant evidence, the scale presents adequate evidence. Reliability levels were also good. Previously, the psychometric properties of the ZBI have not been studied in caregivers of people with intellectual disabilities, and it represents the first study of the scale in Peru. The results obtained will allow the use of this scale to design actions in the work with caregivers and studies to understand the psychology of the caregiver.
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Affiliation(s)
| | - Rubí Paredes-Angeles
- Grupo de Estudios Avances en Medición Psicológica, Universidad Nacional Mayor de San Marcos, Lima, Peru.,Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Arnold Alejandro Tafur-Mendoza
- Grupo de Estudios Avances en Medición Psicológica, Universidad Nacional Mayor de San Marcos, Lima, Peru.,Research Center (CIUP), Universidad del Pacífico, Lima, Peru
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Tu JY, Jin G, Chen JH, Chen YC. Caregiver Burden and Dementia: A Systematic Review of Self-Report Instruments. J Alzheimers Dis 2022; 86:1527-1543. [DOI: 10.3233/jad-215082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: As the demand for dementia care grows rapidly worldwide, heavy “caregiver burden” has been associated with stress and depression. Even so, standard metrics for interdisciplinary research of caregiver burden are limited. Objective: The objective of the present review is to recommend valid, reliable, and comprehensive self-report instruments of caregiver burden. Methods: A systematic review was performed using four databases, searched in April 2021. Articles that established or evaluated self-report instruments for dementia caregiver burden were included, while studies that involved non-dementia caregivers or did not clearly define caregiver burden were excluded. Established guidelines for reliability and agreement studies were used to assess quality and risk of bias. Assessments of self-report instruments were made based on reliability, validity, feasibility, and quality of psychometric evaluations, and comparative evaluations were presented in visual form using radar graphs. Results: Search terms yielded 1,720 articles, and 40 were included in the systematic review after excluding those of low quality. Based on the results of these studies, we recommend the Zarit Burden Interview, Screen for Caregiver Burden, Caregiver Burden Interview, and Burden Scale for Family Caregivers, due to their validity, reliability, and inclusion of multiple subjective and objective dimensions of burden. Conclusion: Targeting specific sources of caregiver burden can help prevent negative outcomes for both dementia patients and caregivers. Future studies should apply self-report instruments to measure and address caregiver burden longitudinally.
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Affiliation(s)
| | | | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan
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12
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Lou VW, Tang JYM, Lau GKK, Lum TYS, Fong K, Ko RWT, Cheng CYM, Fu JY, Chow ESL, Chu ACK, Hui E, Ng WWL, Chan FHW, Luk CC, Kwok TK. Effectiveness of a Two-Tier Family-Oriented Intervention in Enhancing the Family Functioning and Care Capacity of the Family Caregivers of Stroke Survivors: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e16703. [PMID: 34047707 PMCID: PMC8196356 DOI: 10.2196/16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 08/08/2020] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Stroke has profound impacts on families. Often, family members, including stroke survivors and the person who takes up the role of the primary caregiver, would encounter demands on finances, rehabilitation arrangement, and even conflicts. Hence, a family-oriented intervention is expected to enable families to rebuild internal and external resources to achieve optimal rehabilitation and community reintegration. Objective This study aims to describe a design of a two-tier family-oriented care management intervention for enhancing the family functioning and care capacity of the caregivers of stroke survivors. Methods The two-tier care management intervention was guided by a standardized protocol conducted by trained professional care managers (first tier) with the support of trained volunteers (second tier), which lasted for 8-12 weeks. Participants were recruited through collaborating hospitals according to inclusion and exclusion criteria. In order to examine the effectiveness and cost-effectiveness of the two-tier care management intervention, a two-arm randomization multicenter study was designed, including an active comparison group, which was guided by a standardized protocol conducted by trained volunteers. Dyadic participants, including both stroke survivors and their primary caregivers for both groups, were invited to participate in a questionnaire survey using standardized and purposefully developed measures 3 times: before the intervention, immediately after the intervention, and 2 months after the intervention. The primary outcome was family functioning measured by the Family Role Performance Scale and Family Assessment Device-General Functioning Scale. The secondary outcomes included caregiving burden, depressive symptoms, care management strategies, and the incremental cost-effectiveness ratio. Results Recruitment began in January 2017 and was completed at the end of April 2019. Data collection was completed at the end of March 2020. As of March 2020, enrollment has been completed (n=264 stroke caregivers). A total of 200 participants completed the baseline questionnaires. We aim to publish the results by mid-2021. Conclusions This study successfully developed a two-tier care management protocol that aims to enhance the family functioning of the caregivers of stroke survivors. Guided by a standardized protocol, this family-oriented two-tier intervention protocol was found to be feasible among Chinese families. Trial Registration ClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330 International Registered Report Identifier (IRRID) RR1-10.2196/16703
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Affiliation(s)
- Vivian Weiqun Lou
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Gary Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kenneth Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Rachel Wai Tung Ko
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Joyce Yinqi Fu
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Eddie Siu Lun Chow
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Angus Chun Kwok Chu
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Winnie Wing Ling Ng
- Department of Medicine and Geriatrics, Shatin Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - Felix Hon Wai Chan
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - C C Luk
- Queen Mary Hospital, Hospital Authority, Hong Kong, Hong Kong
| | - T K Kwok
- Division of Rehabilitation Medicine, Tung Wah Hospital, Hospital Authority, Hong Kong, Hong Kong
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13
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Chan CY, Cheung G, Martinez-Ruiz A, Chau PYK, Wang K, Yeoh EK, Wong ELY. Caregiving burnout of community-dwelling people with dementia in Hong Kong and New Zealand: a cross-sectional study. BMC Geriatr 2021; 21:261. [PMID: 33879099 PMCID: PMC8059033 DOI: 10.1186/s12877-021-02153-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 03/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Informal caregiving for people with dementia can negatively impact caregivers’ health. In Asia-Pacific regions, growing dementia incidence has made caregiver burnout a pressing public health issue. A cross-sectional study with a representative sample helps to understand how caregivers experience burnout throughout this region. We explored the prevalence and contributing factors of burnout of caregivers of community-dwelling older people with dementia in Hong Kong (HK), China, and New Zealand (NZ) in this study. Methods Analysis of interRAI Home Care Assessment data for care-recipients (aged ≥65 with Alzheimer’s disease/other dementia) who had applied for government-funded community services and their caregivers was conducted. The sample comprised 9976 predominately Chinese in HK and 16,725 predominantly European in NZ from 2013 to 2016. Caregiver burnout rates for HK and NZ were calculated. Logistic regression was used to determine the adjusted odds ratio (AOR) of the significant factors associated with caregiver burnout in both regions. Results Caregiver burnout was present in 15.5 and 13.9% of the sample in HK and NZ respectively. Cross-regional differences in contributing factors to burnout were found. Care-recipients’ ADL dependency, fall history, and cohabitation with primary caregiver were significant contributing factors in NZ, while primary caregiver being child was found to be significant in HK. Some common contributing factors were observed in both regions, including care-recipients having behavioural problem, primary caregiver being spouse, providing activities-of-daily-living (ADL) care, and delivering more than 21 h of care every week. In HK, allied-health services (physiotherapy, occupational therapy and speech therapy) protected caregiver from burnout. Interaction analysis showed that allied-health service attenuates the risk of burnout contributed by care-recipient’s older age (85+), cohabitation with child, ADL dependency, mood problem, and ADL care provision by caregivers. Conclusions This study highlights differences in service delivery models, family structures and cultural values that may explain the cross-regional differences in dementia caregiving experience in NZ and HK. Characteristics of caregiving dyads and their allied-health service utilization are important contributing factors to caregiver burnout. A standardized needs assessment for caregivers could help policymakers and healthcare practitioners to identify caregiving dyads who are at risk of burnout and provide early intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02153-6.
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Affiliation(s)
- Crystal Y Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Adrian Martinez-Ruiz
- Instituto Nacional De Geriatría, Mexico City, Mexico.,Department of Population Health, University of Auckland, Auckland, New Zealand
| | - Patsy Y K Chau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kailu Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza L Y Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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14
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Perceived Help-Seeking Difficulty, Barriers, Delay, and Burden in Carers of People with Suspected Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062956. [PMID: 33805808 PMCID: PMC7999253 DOI: 10.3390/ijerph18062956] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022]
Abstract
Because of an often complicated and difficult-to-access care system, help-seeking for people with suspected dementia can be stressful. Difficulty in help-seeking may contribute to carer burden, in addition to other known stressors in dementia care. This study examined the relationship between perceived help-seeking difficulty and carer burden, and the barriers contributing to perceived difficulty. We interviewed 110 carers accessing a community-based dementia assessment service for suspected dementia of a family member for their perceived difficulty, delays, and barriers in help-seeking, and carers burden in terms of role strain, self-criticism, and negative emotions. Linear regression models showed that perceived help-seeking difficulty is associated with carer self-criticism, while carer role strain and negative emotions are associated with symptom severity of the person with dementia but not help-seeking difficulty. Inadequate knowledge about symptoms, service accessibility, and affordability together explained more than half of the variance in perceived help-seeking difficulty (Nagelkerke R2 = 0.56). Public awareness about symptoms, support in navigating service, and financial support may reduce perceived difficulty in help-seeking, which in turn may reduce carer self-criticism during the early course of illness.
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15
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Çamur S, Batıbay SG, Bayram S. Effect of lower extremity amputation on caregiving burden in caregivers of patients with diabetic foot: Prospective cohort study. Int Wound J 2020; 17:890-896. [PMID: 32219992 DOI: 10.1111/iwj.13342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 01/14/2023] Open
Abstract
Lower extremity amputation as a treatment of diabetic foot ulcer is probably a major burden for the patient's family and friends, who typically act as caregivers and support the patient in coping with the physical disabilities and emotional distress. In the present prospective study, we investigated the effects of different lower extremity amputation levels for diabetic foot ulcer treatment on caregivers of patients with diabetes using the Zarit Burden Interview (ZBI-12) scale. Patients with diabetic foot ulcers who underwent unilateral major amputation (above-below knee) and minor amputation of foot (heel sparing) and their caregivers were requested to volunteer to participate in this study from June 2016 to December 2018. The ZBI-12 form was completed immediately preoperatively and 3 and 6 months after postoperatively. In the minor amputation group, the mean age of the 51 patients was 72.1 years. In the major amputation group, the mean age of the 88 patients was 73.7 years. Both groups of caregivers of patients with minor amputation and major amputations showed a significant improvement in ZBI-12 score when compared preoperatively and at 3- and 6-month follow-up visits. The mean ZBI-12 score was significantly higher in the major than in the minor amputation group in preoperative and all postoperative visits. The absence of the ankle joint in the below- or above-knee amputation renders it more difficult for the amputee to quickly learn the use of prosthesis, thereby increasing the burden of the patient and caregivers. We found that lower extremity amputation for the treatment of chronic diabetic foot ulcers has significantly favourable effect on the caregiver burden, and thereby heel sparing was considerably more effective for the caregiver burden.
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Affiliation(s)
- Savaş Çamur
- Department of Orthopedics and Traumatology, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Sefa G Batıbay
- Department of Orthopedics and Traumatology, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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16
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Pinyopornpanish K, Pinyopornpanish M, Wongpakaran N, Wongpakaran T, Soontornpun A, Kuntawong P. Investigating psychometric properties of the Thai version of the Zarit Burden Interview using rasch model and confirmatory factor analysis. BMC Res Notes 2020; 13:120. [PMID: 32122404 PMCID: PMC7050141 DOI: 10.1186/s13104-020-04967-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Objective The Zarit Burden Interview (ZBI) has been widely used to assess caregiver burden. Few research papers have investigated the Thai version of the ZBI. The study aimed to examine the psychometric properties of the Thai version of both the full length (ZBI-22) and short versions (ZBI-12) using Rasch analysis and confirmatory factor analysis among a sample of Alzheimer’s disease caregivers. Results The ZBI-22 fitted the Rasch measurement model regarding unidimensionality but not for ZBI-12. Five items from ZBI-22, and 2 items from ZBI-12 were shown to be misfitting items. Half of ZBI items were shown to be disordered category or threshold, and were locally dependent. CFA revealed three-factor and four-factor fitted the data the best for ZBI-22 and ZBI-12, respectively. Reliability was good for both forms of the ZBI (α = 0.86–0.92). Significant correlations were found with caregiver’s perceived stress, anxiety/depression, pain and mobility but not with self-care and usual activity (p > 0.05), indicating convergent and discriminant validity. To conclude, the Thai version ZBI-22, but not ZBI-12, supported the reliability and unidimensional scale among Alzheimer’s disease caregivers. Some misfitting items of the ZBI undermined the unidimensionality of the scale, and need revision.
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Affiliation(s)
| | - Manee Pinyopornpanish
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, Thailand
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, Thailand.
| | - Tinakon Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pimolpun Kuntawong
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, Thailand
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17
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Scholten EWM, Hillebregt CF, Ketelaar M, Visser-Meily JMA, Post MWM. Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review. Disabil Rehabil 2019; 43:746-772. [PMID: 31366259 DOI: 10.1080/09638288.2019.1641847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE (1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies. MATERIALS AND METHODS Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies. RESULTS (1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire. CONCLUSIONS There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection. PROSPERO REGISTRATION CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.
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Affiliation(s)
- Eline W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chantal F Hillebregt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMCU Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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18
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Yu J, Yap P, Liew TM. The optimal short version of the Zarit Burden Interview for dementia caregivers: diagnostic utility and externally validated cutoffs. Aging Ment Health 2019; 23:706-710. [PMID: 29553806 DOI: 10.1080/13607863.2018.1450841] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Using a sample of dementia caregivers, we compared the diagnostic utility of the various short versions of the Zarit Burden Interview (ZBI) with the original scale to identify the most optimal one. Next, we established externally validated cutoffs for the various ZBI versions using probable depression cases as a reference standard. METHODS Caregivers (N = 394; 236 males; Agemean = 56 years) were administered the ZBI and a self-report depression measure. Participants who exceeded the cutoff for the latter were identified as probable depression cases. For each of the ZBI versions, a receiver operating characteristic (ROC) curve was plotted against probable depression cases. The area under these ROC curves between the short versions and the original were then compared using a non-parametric approach. RESULTS Compared to the original ZBI, the AUROC were similar for the 6-item, 7-item, and two 12-item versions, but significantly worse for the other short variants. The sensitivity and specificity of the cutoffs for all ZBI versions ranged from 77.3% to 85.2% and 60.1% to 79.8%, respectively. CONCLUSIONS The original ZBI had good utility in identifying probable depression in caregivers, while the 6-item variant can be a useful alternative when short versions are preferred.
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Affiliation(s)
- Junhong Yu
- a Department of Psychology , The University of Hong Kong , Hong Kong
| | - Philip Yap
- b Department of Geriatric Medicine , Khoo Teck Puat Hospital , Singapore.,c Geriatric Education and Research Institute , Singapore
| | - Tau Ming Liew
- d Department of Geriatric Psychiatry , Institute of Mental Health , Singapore.,e Saw Swee Hock School of Public Health , National University of Singapore , Singapore
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19
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Gratão ACM, Brigola AG, Ottaviani AC, Luchesi BM, Souza ÉN, Rossetti ES, de Oliveira NA, Terassi M, Pavarini SCI. Brief version of Zarit Burden Interview (ZBI) for burden assessment in older caregivers. Dement Neuropsychol 2019; 13:122-129. [PMID: 31073389 PMCID: PMC6497029 DOI: 10.1590/1980-57642018dn13-010015] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The degree of burden related to the demands of daily care provided to a dependent older adult is important to evaluate due to the negative influence exerted on caregivers’ physical and psychological health.
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Affiliation(s)
| | - Allan Gustavo Brigola
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Ana Carolina Ottaviani
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Bruna Moretti Luchesi
- PhD. Professors, Universidade Federal do Mato Grosso do Sul - Três Lagoas, MS, Brazil
| | - Érica Nestor Souza
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Estefani Serafim Rossetti
- MSc. Candidate, Graduate Nursing Program, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | - Marielli Terassi
- PhD. Professors, Universidade Federal do Mato Grosso do Sul - Três Lagoas, MS, Brazil
| | - Sofia Cristina Iost Pavarini
- PhD. Professors, Undergraduate Program in Gerontology, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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20
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Yu Y, Liu ZW, Zhou W, Chen XC, Zhang XY, Hu M, Xiao SY. Assessment of Burden Among Family Caregivers of Schizophrenia: Psychometric Testing for Short-Form Zarit Burden Interviews. Front Psychol 2018; 9:2539. [PMID: 30618960 PMCID: PMC6305706 DOI: 10.3389/fpsyg.2018.02539] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/28/2018] [Indexed: 12/26/2022] Open
Abstract
Objective: Although various short forms of Zarit Burden Interview (ZBI) have been developed, there is a lack of standard psychometric testing and comparison among them. The study aims to examine the psychometric properties of ten short versions of the most frequently used ZBI among a sample of schizophrenia caregivers and to find the one with the best performance. Methods: Cross-sectional door-to-door survey of ZBI-22 and a series of validated instrument data from 327 family caregivers of schizophrenia patients in a Chinese rural community were conducted from October 2015 to January 2016. Reliability was assessed using McDonald's omega coefficient (ω). Validity including concurrent validity, known group's validity, and criterion validity were assessed by Spearman correlations and Mann-Whitney U tests. Overall discrimination ability was evaluated using the area under the receiver operating characteristic curve (AUC). Results: Reliability was generally good for all short forms (ω = 0.69–0.84), except for the Gort ZBI-4 (ω = 0.58), which is acceptable considering its small item numbers. Concurrent validity was good across all various ZBI forms with significant negative correlations with patient's function (r = −0.34 to −0.48, p < 0.01), as well as significant positive correlations with caregiver's depression (r = 0.49–0.65, p < 0.01), and anxiety symptoms (r = 0.45–0.58, p < 0.01). Known groups' validity (carers with disease vs. without disease; carers being parents vs. spouse vs. others) showed inconsistent results among various short forms. Criterion validity was generally good for all short forms with significant positive correlations with Family Burden Interview Schedule (r = 0.67–0.75, p < 0.01), except for the Higginson ZBI-1(r = 0.57, p < 0.01). Discriminative ability was also good for all short forms (AUC range: 0.85–0.99), with various cutpoints proposed. Among all ten short forms, the Ballesteros ZBI-12 and the Gort ZBI-7 outperformed others with almost equally good performance in comprehensive psychometric testing. Conclusions: This study provides support for the reliability, validity, and discriminative ability of the ten various short forms of ZBI for use among schizophrenia family caregivers, with the Ballesteros ZBI-12 and the Gort ZBI-7 endorsed as the best ones.
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Affiliation(s)
- Yu Yu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Zi-Wei Liu
- Mental Health Institute of the Second Xiangya Hospital, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Central South University, Changsha, China
| | - Wei Zhou
- Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Chuan Chen
- Traditional Chinese Medical Hospital of Ya'an, Sichuan, China
| | - Xing-Yu Zhang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Mi Hu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Shui-Yuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, China
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21
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Lau BHP, Lou VW, Cheung KSL. Exemplary Care among Chinese Dementia Familial Caregivers. Healthcare (Basel) 2018; 6:healthcare6040141. [PMID: 30563183 PMCID: PMC6315822 DOI: 10.3390/healthcare6040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study investigates the feasibility of using the Exemplary Care Scale (ECS) among Chinese dementia familial caregivers, and reports its psychometric properties. METHOD Back translation was used to develop the Chinese version of ECS (C-ECS). Three hundred and ninety-seven dyads of caregivers and their relatives with dementia responded to an assessment battery which included questions on care recipients' cognition, behavioral and psychological symptoms, daily activities assistance, social support, and caregiver well-being. RESULTS Results of an exploratory principal component analysis revealed two subscales in the 11-item C-ECS: considerate caregiving and preserving esteem. C-ECS and its subscales demonstrated sufficient reliability, as well as criteria-related validity through its association with care recipient's cognition and health, and caregivers' well-being and social support. DISCUSSION Our findings provide preliminary support to C-ECS as a reliable and valid measure of exemplary caregiving among Hong Kong Chinese familial dementia caregivers. In the light of the increasing importance of familial care in dementia care planning, we recommend the use of this brief scale in regular caregiver assessment in research and service delivery.
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Affiliation(s)
- Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, China
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
- Correspondence: (B.H.P.L.); (K.S.L.C.)
| | - Vivian Weiqun Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China;
| | - Karen Siu Lan Cheung
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China;
- Mindlink Research Centre, Hong Kong, China
- Correspondence: (B.H.P.L.); (K.S.L.C.)
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22
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Bai X, Liu C, Baladon L, Rubio-Valera M. Multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Aging Ment Health 2018; 22:980-989. [PMID: 28541777 DOI: 10.1080/13607863.2017.1330872] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective of this study was to examine multidimensional determinants of the caregiving burden among Chinese male caregivers of older family members in Hong Kong. Based on a modified stress process model, this study explored how background and contextual factors (demographic characteristics and mental health status of caregivers, caregiving-related factors, and support and services), primary stressors (degree of care dependency and special care needs), and secondary stressors (self-efficacy and gender role conflict) might affect the caregiving burden among male caregivers. METHOD A questionnaire survey was completed by 204 male caregivers who considered themselves as primary caregivers for older family members with care needs aged 60 and over. Descriptive, bivariate, and multivariate analyses were conducted. RESULTS Being the son of the care receiver, the presence of depressive symptoms, a higher degree of gender role conflict, a lower degree of caregiving self-efficacy, and the use of support and services all predicted greater caregiving burden among male caregivers. CONCLUSION This study established a modified stress process model specifically for male caregivers. Gender role conflict and caregiving self-efficacy were introduced into the model as secondary stressors and found to be significantly associated with the degree of caregiving burden. The findings of this study could inform the development of services and interventions to reduce the caregiving burden among male caregivers.
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Affiliation(s)
- Xue Bai
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong.,b Personal Social Services Research Unit , London School of Economics and Political Science , UK
| | - Chang Liu
- a Department of Applied Social Sciences , The Hong Kong Polytechnic University , Hong Kong
| | - Luisa Baladon
- c Adults Mental Health Centre of Garraf , Parc Sanitari Sant Joan De Déu , Barcelona , Spain
| | - Maria Rubio-Valera
- d Research and Teaching Unit , Fundació Sant Joan de Déu , Spain.,e Centre For Biomedical Research in Epidemiology and Public Health, CIBERESP , Madrid , Spain.,f School of Pharmacy , Universitat de Barcelona , Barcelona , Spain
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23
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Li R, Chong MS, Chan PCM, Tay BGL, Ali NB, Lim WS. Worry About Caregiving Performance: A Confirmatory Factor Analysis. Front Med (Lausanne) 2018; 5:79. [PMID: 29623277 PMCID: PMC5874286 DOI: 10.3389/fmed.2018.00079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/08/2018] [Indexed: 11/30/2022] Open
Abstract
Recent studies on the Zarit Burden Interview (ZBI) support the existence of a unique factor, worry about caregiving performance (WaP), beyond role and personal strain. Our current study aims to confirm the existence of WaP within the multidimensionality of ZBI and to determine if predictors of WaP differ from the role and personal strain. We performed confirmatory factor analysis (CFA) on 466 caregiver-patient dyads to compare between one-factor (total score), two-factor (role/personal strain), three-factor (role/personal strain and WaP), and four-factor models (role strain split into two factors). We conducted linear regression analyses to explore the relationships between different ZBI factors with socio-demographic and disease characteristics, and investigated the stage-dependent differences between WaP with role and personal strain by dyadic relationship. The four-factor structure that incorporated WaP and split role strain into two factors yielded the best fit. Linear regression analyses reveal that different variables significantly predict WaP (adult child caregiver and Neuropsychiatric Inventory Questionnaire (NPI-Q) severity) from role/personal strain (adult child caregiver, instrumental activities of daily living, and NPI-Q distress). Unlike other factors, WaP was significantly endorsed in early cognitive impairment. Among spouses, WaP remained low across Clinical Dementia Rating (CDR) stages until a sharp rise in CDR 3; adult child and sibling caregivers experience a gradual rise throughout the stages. Our results affirm the existence of WaP as a unique factor. Future research should explore the potential of WaP as a possible intervention target to improve self-efficacy in the milder stages of burden.
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Affiliation(s)
- Ruijie Li
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore.,Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mei Sian Chong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Peng Chew Mark Chan
- Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Institute of Geriatrics and Active Ageing, National Healthcare Group, Singapore, Singapore
| | | | - Noorhazlina Binte Ali
- Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Institute of Geriatrics and Active Ageing, National Healthcare Group, Singapore, Singapore
| | - Wee Shiong Lim
- Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore, Singapore.,Institute of Geriatrics and Active Ageing, National Healthcare Group, Singapore, Singapore
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24
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Tang B, Yu Y, Liu Z, Lin M, Chen Y, Zhao M, Xiao S. Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community. BMJ Open 2017; 7:e015621. [PMID: 28965090 PMCID: PMC5640094 DOI: 10.1136/bmjopen-2016-015621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the factor structure of the Chinese version of the 22-item Zarit Burden Interview (ZBI) among family caregivers of patients with schizophrenia in China. METHODS Using one-stage cluster-sampling design, 324 primary caregivers of patients with schizophrenia in Ningxiang County, Hunan Province, China, completed the Zarit Burden Interview face-to-face. Confirmatory factor analysis (CFA) was first performed based on existing models to check model fit. Owing to an unsatisfactory result of CFA, exploratory factor analysis (EFA) was then conducted to explore a new factor structure, and a subsequent CFA was run to examine its model fit. RESULTS The CFA results showed that none of the existing models fit the data reasonably well. The EFA results suggested five dimensions: negative emotion (10 items), interpersonal relationship (4 items), time demand (3 items), patient's dependence (2 items) and self-accusation and guilt (2 items). The following CFA confirmed the five-factor solution in this study, and the goodness-of-fit for this model fell within the acceptable range. The overall internal consistency (Cronbach's alpha) was 0.88, and the internal consistency coefficients of individual dimensions were 0.68 to 0.84. CONCLUSION This study supported a 22-item ZBI scale, with a five-factor structure when applied to Chinese caregivers of patients with schizophrenia.
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Affiliation(s)
- Bingwei Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Hospital Evaluation Office, Xiangya Hospital Central South University, Changsha, China
| | - Ziwei Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Meijuan Lin
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yumei Chen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mei Zhao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Abstract
OBJECTIVES Gratitude is widely perceived as a key factor to psychological well-being by different cultures and religions. The relationship between gratitude and coping in the context of familial dementia caregiving has yet to be investigated. DESIGN This study is the first to examine the associations among gratitude, coping strategies, psychological resources and psychological distress using a structural equation modelling approach. RESULTS Findings with 101 Chinese familial caregivers of persons with dementia (mean age = 57.6, range = 40-76; 82% women) showed that gratitude was related to the greater use of emotion-focused coping (positive reframing, acceptance, humour, emotional social support seeking, religious coping) and psychological resources (caregiving competence and social support). Psychological resources and emotion-focused coping in turn explained the association between gratitude and lower levels of psychological distress (caregiving burden and depressive symptoms). CONCLUSION The present results indicate the beneficial role of gratitude on coping with caregiving distress and provide empirical foundation for incorporating gratitude in future psychological interventions for caregivers.
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Affiliation(s)
- Bobo Hi-Po Lau
- a Department of Social Work and Social Administration , University of Hong Kong , Hong Kong
| | - Cecilia Cheng
- b Department of Psychology , University of Hong Kong , Hong Kong
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Bień-Barkowska K, Doroszkiewicz H, Bień B. Silent strain of caregiving: exploring the best predictors of distress in family carers of geriatric patients. Clin Interv Aging 2017; 12:263-274. [PMID: 28203067 PMCID: PMC5295808 DOI: 10.2147/cia.s125664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives The aim of this article was to identify the best predictors of distress suffered by family carers (FCs) of geriatric patients. Methods A cross-sectional study of 100 FC-geriatric patient dyads was conducted. The negative impact of care (NIoC) subscale of the COPE index was dichotomized to identify lower stress (score of ≤15 on the scale) and higher stress (score of ≥16 on the scale) exerted on FCs by the process of providing care. The set of explanatory variables comprised a wide range of sociodemographic and care-related attributes, including patient-related results from comprehensive geriatric assessments and disease profiles. The best combination of explanatory variables that provided the highest predictive power for distress among FCs in the multiple logistic regression (LR) model was determined according to statistical information criteria. The statistical robustness of the observed relationships and the discriminative power of the model were verified with the cross-validation method. Results The mean age of FCs was 57.2 (±10.6) years, whereas that of geriatric patients was 81.7 (±6.4) years. Despite the broad initial set of potential explanatory variables, only five predictors were jointly selected for the best statistical model. A higher level of distress was independently predicted by lower self-evaluation of health; worse self-appraisal of coping well as a caregiver; lower sense of general support; more hours of care per week; and the motor retardation of the cared-for person measured with the speed of the Timed Up and Go (TUG) test. Conclusion Worse performance on the TUG test was only the patient-related predictor of distress among the variables examined as contributors to the higher NIoC. Enhancing the mobility of geriatric patients through suitably tailored kinesitherapeutic methods during their hospital stay may mitigate the burden endured by FCs.
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Affiliation(s)
| | | | - Barbara Bień
- Department of Geriatrics, Medical University of Białystok, Białystok, Poland
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