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Sánchez-Alcón M, Sánchez-Ramos JL, Garrido-Fernández A, Sosa-Cordobés E, Ortega-Galán ÁM, Ramos-Pichardo JD. Effectiveness of interventions aimed at improving grief and depression in caregivers of people with dementia: A systematic review and meta-analysis. Int J Ment Health Nurs 2023; 32:1211-1224. [PMID: 36971150 DOI: 10.1111/inm.13142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of people suffering from dementia may go through a grieving process prior to the death of the cared-for person, which is related to mental health and physical problems. Interventions aimed at improving grief and depression are being used in response to these difficulties. The aim of this study was to synthesize and evaluate the evidence for the effectiveness of interventions aimed at improving the grief process in home-based caregivers of people with dementia with the aim of reducing grief and depression. A systematic review, including a meta-analysis, was designed. Following the PRISMA guideline, original articles were searched in the databases: Medline, WOS, Scopus and PsycINFO, up to September 2022. Articles that evaluated interventions aimed at improving the grief process in caregivers of people with dementia, whose care recipients were alive at the beginning of the study at minimum and living at home were selected. Grief and depression were considered outcome variables. A meta-analysis was carried out with a fixed effects model for these variables and for the domains of the Caregiver Grief Scale (CGS). Eight articles met the inclusion and exclusion criteria. Most of the interventions aimed at improving the grief process showed an improvement in grief and depression. The 'emotional pain' and 'absolute loss' domains of the CGS stood out with an improvement in these variables. Interventions aimed at improving the grief process are relatively effective in reducing grief and depression. Interventions that are even more effective and more robust studies are needed.
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2
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Wrede N, Töpfer NF, Wilz G. Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers. J Clin Psychol 2023; 79:2207-2224. [PMID: 37192433 DOI: 10.1002/jclp.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers. METHODS In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-six therapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models. RESULTS Caregiver burden was significantly predicted by caregiver-rated emotional bond (β = -0.18) as well as therapist-rated resource activation (β = -0.26), problem actuation (β = -0.22), clarification of meaning (β = -0.18), and mastery (β = -0.18). None of the GCMs predicted depression from any perspective. CONCLUSION The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.
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Affiliation(s)
- Nicolas Wrede
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller-University Jena, Jena, Germany
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Crawley S, Sampson EL, Moore KJ, Kupeli N, West E. Grief in family carers of people living with dementia: A systematic review. Int Psychogeriatr 2023; 35:477-508. [PMID: 35086600 DOI: 10.1017/s1041610221002787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Grief research in family carers of people with dementia has increased. We aimed to report the prevalence of pre-death and post-death grief and to synthesize associated factors and the relationship between pre-death factors and post-death grief and services used to manage grief. DESIGN (Prospero protocol: CRD42020165071) We systematically reviewed literature from PsycINFO, MEDLINE, CINAHL, and ASSIA until April 2020. Effectiveness of intervention data and studies not written in English were excluded; qualitative studies were additionally excluded during study selection. Study quality was assessed using the Mixed Methods Appraisal Tool. Evidence was narratively summarized. PARTICIPANTS Family non-paid carers of somebody with any dementia type. MEASUREMENTS Validated measures of pre-death and/or post-death grief. RESULTS We included quantitative data from 55 studies (44 rated as high quality). Most included solely spouse or adult child carers. Forty-one studies reported pre-death grief, 12 post-death grief, and 6 service use; eight were longitudinal. 17% met the Prolonged Grief Disorder criteria pre-death (n = 1) and 6-26% (n = 4) of participants met the Complicated Grief criteria post-death. Being a spouse, less educated, caring for somebody with advanced dementia, and greater burden and depression were associated with higher pre-death grief. Lower education level and depression were predictive of higher post-death grief. Pre-death factors found to influence post-death grief were grief and depression. Limited service use evidence was reported. CONCLUSION Awareness of characteristics which increase the likelihood of higher grief can help identify those in need of support. Future research should focus on what supports or services are beneficial to grief experiences.
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Affiliation(s)
- Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | | | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Nuriye Kupeli
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
| | - Emily West
- Division of Psychiatry, UCL, LondonW1T 7NF, United Kingdom
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Mossello E, Baccini M, Caramelli F, Biagini CA, Cester A, De Vreese LP, Darvo G, Vampini C, Gotti M, Fabbo A, Marengoni A, Cavallini MC, Gori G, Chattat R, Marini M, Ceron D, Lanzoni A, Pizziolo P, Mati A, Zilli I, Cantini C, Caleri V, Tonon E, Simoni D, Mecocci P, Ungar A, Masotti G. Italian guidance on Dementia Day Care Centres: A position paper. Aging Clin Exp Res 2023; 35:729-744. [PMID: 36795236 PMCID: PMC9933825 DOI: 10.1007/s40520-023-02356-4] [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: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.
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Affiliation(s)
- Enrico Mossello
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy.
| | | | - Francesca Caramelli
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | | | | | - Luc Pieter De Vreese
- Department of Mental Health and Addictions, Cognitive Clinic, Azienda USL Modena, Italy
| | - Gianluca Darvo
- Department of Architecture, University of Florence, Florence, Italy
| | - Claudio Vampini
- Psychiatric and Psychogeriatric Service, San Francesco Hospital, Garofalo Health Care, Verona, Italy
| | - Mabel Gotti
- Psychotherapist and Psychoanalyst, Italian Society of Interpersonal Psychoanalysis, Florence, Italy
| | - Andrea Fabbo
- Cognitive Disorders and Dementia Unit, Health Authority and Services of Modena, Modena, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Cavallini
- Continuity of Care Agency, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Gori
- Scientific Director, PAS Pubbliche Assistenze Foundation, Florence, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Monica Marini
- Staff Coordinator, Healthcare Executive, Tuscany Region, Italy
| | - Davide Ceron
- Opera Immacolata Concezione Foundation, Padua, Italy
| | - Alessandro Lanzoni
- Cognitive Disorders and Dementia Unit, Primary Care Department, Health District of Modena, Modena, Italy
| | | | | | | | | | | | | | - David Simoni
- Health Area Manager, Arnera Cooperativa Sociale, Pontedera, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | - Giulio Masotti
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
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Hähnel FS, Töpfer NF, Wilz G. Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study. Aging Ment Health 2023; 27:101-109. [PMID: 34983260 DOI: 10.1080/13607863.2021.2022598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories. METHODS Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline - T0, 6 months - T1, and 12 months - T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92). RESULTS NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC. CONCLUSIONS The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .
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Affiliation(s)
- Flora S Hähnel
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Nils F Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich-Schiller University Jena, Jena, Germany
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Dehpour T, Koffman J. Assessment of anticipatory grief in informal caregivers of dependants with dementia: a systematic review. Aging Ment Health 2023; 27:110-123. [PMID: 35168426 DOI: 10.1080/13607863.2022.2032599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Informal caregivers of dependants with dementia commence their bereavement experience long before the physical death of their dependant, a process referred to as "anticipatory grief". This represents an ambiguous state that has been acknowledged as a measurable variable among informal caregivers. The use of assessment tools for the identification of anticipatory grief is important for timely intervention to promote well-being and positive bereavement experiences. The aim of this systematic review is to identify and examine existing tools for assessing anticipatory grief among caregivers of dependants with dementia. METHODS MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science were searched to July 2021. Studies focusing on the development/evaluation of instruments for measuring anticipatory grief in dementia caregivers were eligible. The quality of each measurement was graded as positive, fair, poor or no information based on defined criteria. RESULTS 100 studies were identified. 33 papers were selected for full-text assessment and 12 papers met the eligibility criteria. Seven assessment tools were identified for measurement of pre-death grief caregivers - the Anticipatory Grief Scale (AGS), Marwit-Meuser Caregiver Grief Inventory (MM-CGI), MM-CGI-short-form (MM-CGI-SF), MM-CGI-brief (MM-CGI-BF), Prolonged Grief Scale (PG-12), Caregiver Grief Scale (CGS) and Caregiver Grief Questionnaire (CGQ). Based on content/construct validity, internal consistency and test-retest reliability the MM-CGI/MM-CGI-SF scored highest for quality followed by the CGS. CONCLUSION Anticipatory grief in dementia has multiple facets that can be measured using self-scoring questionnaires. Our findings provide support for different measures of anticipatory grief. Further research is needed for the evaluation of the responsiveness and interpretability of these instruments.
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Affiliation(s)
- Tara Dehpour
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Jonathan Koffman
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Theurer C, Wilz G. Opportunities for fostering a positive therapeutic relationship in an Internet‐based cognitive behavioural therapy for dementia caregivers. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Christina Theurer
- Institute of Psychology, Department of Counseling and Clinical Psychology Friedrich Schiller University Jena Jena Germany
| | - Gabriele Wilz
- Institute of Psychology, Department of Counseling and Clinical Psychology Friedrich Schiller University Jena Jena Germany
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8
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Brooks D, Beattie E, Edwards H, Fielding E, Gaugler JE. Pilot Study of the Residential Care Transition Module to Support Australian Spouses of People with Dementia. Clin Gerontol 2022; 45:1130-1143. [PMID: 34962455 DOI: 10.1080/07317115.2021.1988023] [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] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Spouses are at risk of poor psychosocial outcomes following placement of their partner with dementia into long-term care. The Residential Care Transition Module (RCTM) is a psychosocial intervention developed in the United States to support carers post-placement. This study aimed to test the RCTM delivered by telephone to Australian spousal carers. METHODS A small-scale RCT [N = 21] was conducted to test feasibility of recruitment, retention, acceptability, and preliminary effects on measures of stress, grief, depression, guilt, quality-of-life, and satisfaction with care, compared to a group receiving printed information. RESULTS The Transition Counselor and study participants considered the intervention delivery, dose, and content as acceptable. Retention was high (91%). At follow-up, significant time effects were found for stress, depression and "nursing home hassles." A significant interaction effect was found for quality-of-life in favor of the comparison group. No effects were found for guilt or overall grief, however a promising result regarding the sub-scale of "acceptance of loss" was found in favor of the RCTM. CONCLUSIONS The delivery of the RCTM to Australian spousal carers was feasible and acceptable. CLINICAL IMPLICATIONS The RCTM shows potential for improving support to spouses of people with dementia following long-term care placement.
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Affiliation(s)
- Deborah Brooks
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Helen Edwards
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, Queensland University of Technology, Brisbane, Australia
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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9
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Gilsenan J, Gorman C, Shevlin M. Explaining caregiver burden in a large sample of UK dementia caregivers: The role of contextual factors, behavioural problems, psychological resilience, and anticipatory grief. Aging Ment Health 2022:1-8. [PMID: 35881027 DOI: 10.1080/13607863.2022.2102138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Dementia caregiver burden is a significant public health concern, affecting both the wellbeing of caregivers and their care-recipients. This study investigated a range of variables associated with caregiver burden in a large sample of UK dementia caregivers. Clinical characteristics and novel psychological constructs were used - including anticipatory grief and psychological resilience. Anticipatory grief refers to the process of experiencing loss prior to the death of a significant person. METHOD Caregivers of persons with dementia (N = 530) completed a survey obtaining the Zarit-Burden Interview (ZBI-SF) and other psychological and demographic/caregiving-related factors. RESULTS Findings illustrate that 71% of the sample experienced high levels of caregiver burden and around 95% met the criteria for clinically significant levels of burden. A regression model explained 49% of the variance in subjective caregiver burden; contextual factors (care-recipients living situation, frequency of caregiving), behavioural challenges in the care-recipient (memory-related problem behaviours), caregiver psychological resilience and caregiver anticipatory grief (heartfelt long & sadness, worry & felt isolation) were all significant variables. Caregiver anticipatory grief, followed by psychological resilience, had the strongest association with burden. CONCLUSION Caregiver anticipatory grief and psychological resilience, have a significant interaction with the clinical presentation of the dementia sufferer in explaining subjective caregiver burden. More grief and resilience-focused interventions targeting both the practical and emotional challenges are imperative to reduce burden and thus to ensure caregiver wellbeing.
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Affiliation(s)
- Jane Gilsenan
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
| | - Colin Gorman
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, United Kingdom of Great Britain and Northern Ireland
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10
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Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Scher C, Crawley S, Cooper C, Sampson EL, Moore KJ. Usefulness and acceptability of an animation to raise awareness to grief experienced by carers of individuals with dementia. DEMENTIA 2022; 21:363-379. [PMID: 34465234 DOI: 10.1177/14713012211041259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Many carers of individuals with dementia experience high levels of grief before and after the death of the person with dementia. This study aimed to determine the usefulness, acceptability, and relevance of an animation developed to raise awareness to grief experienced by carers of people with dementia. METHODS This research had a cross-sectional survey design. We contacted carers of people with dementia over the phone or email. Participants evaluated the animation through an online or paper-based survey. We used descriptive statistics and analysed qualitative data using thematic analysis. We required a sample of 40 carers to adequately power the study with a target of 75% of carers finding the animation useful, acceptable, and relevant. RESULTS 31/78 carers approached evaluated the animation. Ninety-four percent of participants found the animation relevant to their situation, meeting our target. However, we fell short of this target for usefulness (68%) and acceptability (73%). The qualitative responses suggested that participants felt the animation could help improve the understanding of grief among carers, family, friends, and healthcare professionals. Carers also shared that the animation would be most useful for carers of newly diagnosed people with dementia. CONCLUSION Most carers of people with dementia in this study reported that the animation was useful, acceptable, and relevant. Dissemination of the resource may be useful for the majority of carers, with the caveat that a few carers may find it distressing and need to be referred for further support.
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Affiliation(s)
- Clara Scher
- Rutgers University School of Social Work, New Brunswick, NJ, USA.,Division of Psychiatry, 384708University College London, London, UK
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, 325312University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, 4919University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, 4919University College London, London, UK.,Barnet, Enfield and Haringey Mental Health Trust, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, 4919University College London, London, UK.,National Ageing Research Institute, Parkville, VIC, Australia
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12
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Ney DB, Peterson A, Karlawish J. The ethical implications of paradoxical lucidity in persons with dementia. J Am Geriatr Soc 2021; 69:3617-3622. [PMID: 34628640 PMCID: PMC9924090 DOI: 10.1111/jgs.17484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
This case report describes the ethical implications of paradoxical lucidity in persons with severe stage dementia. Paradoxical lucidity describes an episode of unexpected communication or connectedness in a person who is believed to be noncommunicative due to a progressive and pathological process that causes dementia. A caregiver who witnesses an event of paradoxical lucidity may experience it as ethically and emotionally transformative. We provide an ethical framework for addressing this event in clinical practice. The framework addresses clinician interactions with the patient, caregiver, and family to improve understanding of paradoxical lucidity and to enhance patient care, caregiver well-being, and decision-making. Participants for this case study consented to having the case published. Participant names are changed to protect confidentiality.
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Affiliation(s)
- David B. Ney
- Sidney Kimmel Medical College, Thomas Jefferson University,Penn Program on Precision Medicine for the Brain, Penn Memory Center
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University,Penn Program on Precision Medicine for the Brain, Penn Memory Center
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center, Perelman School of Medicine, University of Pennsylvania,Penn Program on Precision Medicine for the Brain, Penn Memory Center
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13
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Theurer C, Wilz G, Lechner-Meichsner F. Clients' and therapists' experiences of five general change mechanisms during an Internet-based cognitive behavioral intervention for family caregivers. J Clin Psychol 2021; 77:2798-2816. [PMID: 34599844 DOI: 10.1002/jclp.23253] [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: 03/27/2021] [Revised: 07/15/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Despite its efficacy, little is known about what makes Internet-based cognitive behavioral therapy (iCBT) effective. We, therefore, analyze participants' and therapists' experiences of Grawe's five general change mechanisms (alliance, resource activation, clarification, problem actuation, mastery) during an iCBT intervention for family dementia caregivers, and how their experiences were related to treatment outcomes. METHOD Participants (N = 30) exchanged eight weekly messages with a therapist via an Internet platform. We used the Bern Post Session Report to assess participants' and therapists' experiences of the general change mechanisms after each session. RESULTS Treatment outcomes were associated with therapists' overall experiences of alliance, clarification, and mastery. Participants experienced more problem actuation than therapists. Only participants' and therapists' experiences of clarification over time differed. CONCLUSIONS Grawe's general change mechanisms are also relevant for iCBT. We recommend considering Grawe's framework when designing Internet-based therapeutic interventions and when training therapists to deliver such interventions.
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Affiliation(s)
- Christina Theurer
- Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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14
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Kunicki ZJ, Gaudiano BA, Miller IW, Tremont G, Salloway S, Darling E, Broughton MK, Kraines MA, Hoopes R, Epstein-Lubow G. Differences in Burden Severity in Adult-Child Family Caregivers and Spousal Caregivers of Persons with Dementia. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:518-532. [PMID: 33820479 DOI: 10.1080/01634372.2021.1912242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
Researchers are continuing to focus on the nature and sources of burden of family caregivers of persons living with dementia. Caregiving stress and burden are assessed and addressed by social workers, including at high-risk times such as hospitalization. This study tested whether adult-child family caregivers experience greater perceived burden than spousal caregivers, accounting for risks of acute stress which can accompany hospitalization for their care recipient, where social workers may be meeting with family caregivers for the first time. Family caregivers (N = 76; n = 42 adult-child; n = 34 spouse) were recruited during care-recipient clinical treatment. The settings of care included an outpatient memory care program and an inpatient geriatric psychiatry service. Results showed that adult-child caregivers reported greater burden as compared with spousal caregivers, but no differences regarding depressive symptoms, perceived stress, or grief. After controlling for demographics and location of care, being an adult-child caregiver remained a predictor of greater burden severity. Being an adult-child family caregiver may place an individual at increased risk for experiencing high burden. These findings suggest socials workers should consider how adult-child caregivers may benefit from strategies to address and reduce burden, beyond those typically offered to spousal caregivers.
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Affiliation(s)
- Zachary J Kunicki
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Brandon A Gaudiano
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Ivan W Miller
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Geoffrey Tremont
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Stephen Salloway
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Brown University, The Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Ellen Darling
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | | | - Morganne A Kraines
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Ryan Hoopes
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Gary Epstein-Lubow
- Brown University, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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15
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Bravo-Benítez J, Cruz-Quintana F, Fernández-Alcántara M, Pérez-Marfil MN. Intervention Program to Improve Grief-Related Symptoms in Caregivers of Patients Diagnosed With Dementia. Front Psychol 2021; 12:628750. [PMID: 33643160 PMCID: PMC7905313 DOI: 10.3389/fpsyg.2021.628750] [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: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
The objectives of the present study were to adapt a grief intervention program to family caregivers of patients with dementia, and assess its effectiveness in improving the symptoms of grief and other health-related variables. The intervention was based on Shear and Bloom's grief intervention program, with the necessary adaptations for use in the grieving process for a family member's illness. A total of 52 family caregivers of individuals with dementia participated. They were evaluated using a battery of self-report measures assessing grief, overload, resilience, post-traumatic growth, experiential avoidance, health-related quality of life, and benefits of care. The results suggest that the program is effective in improving grief symptoms, caregiver burden, resilience, post-traumatic growth, and quality of life of family caregivers. It is necessary to create and implement interventions targeting caregivers' feelings and manifestations of ambiguous grief, because there is a lack of programs providing an efficient solution for the mental and physical health of caregivers, and because of the human and socioeconomic cost involved in neglecting this group.
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Affiliation(s)
- Jorge Bravo-Benítez
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain
| | - Francisco Cruz-Quintana
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
| | | | - María Nieves Pérez-Marfil
- Mind, Brain, and Behavior Resarch Center (CIMCYC, Centro de Investigación Mente, Cerebro y Comportamiento), University of Granada, Granada, Spain.,Faculty of Psychology, University of Granada, Granada, Spain
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16
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Wiegelmann H, Speller S, Verhaert LM, Schirra-Weirich L, Wolf-Ostermann K. Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia - a systematic literature review. BMC Geriatr 2021; 21:94. [PMID: 33526012 PMCID: PMC7849618 DOI: 10.1186/s12877-021-02020-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02020-4.
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Affiliation(s)
- Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.
| | - Sarah Speller
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Lisa-Marie Verhaert
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Liane Schirra-Weirich
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
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17
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Pfeiffer K, Theurer C, Büchele G, Babac A, Dick H, Wilz G. Relieving distressed caregivers (ReDiCare study): study protocol of a randomized pragmatic trial. BMC Geriatr 2021; 21:4. [PMID: 33407195 PMCID: PMC7787127 DOI: 10.1186/s12877-020-01941-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Providing care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists. METHODS/ DESIGN A pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective. DISCUSSION While comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps. TRIAL REGISTRATION Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 ( www.drks.de, registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593 ( https://apps.who.int/trialsearch/ ).
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Affiliation(s)
- Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Helene Dick
- Institute of Health Care and Public Management, University of Hohenheim, Stuttgart, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
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18
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Byeon H. Effects of Grief Focused Intervention on the Mental Health of Dementia Caregivers: Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2275-2286. [PMID: 34178734 PMCID: PMC8215047 DOI: 10.18502/ijph.v49i12.4808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: The objectives of this study were to review systematically the effects of grief-focused interventions, applied to dementia caregivers, on emotional burden including sadness and to provide baseline information for dementia caregivers to maintain mental health by identifying the effect size of intervention using a meta-analysis. Methods: We evaluated literature published from Jan 1, 2000, to Jun 28, 2019. Consequently, we selected five studies to conduct a systematic review. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields was used for conducting a quality assessment on the selected literature. Results: The results of the quality assessment showed that the score ranged from 11 to 24 points: one strong, one good, two adequate, and one limited. When the meta-mean was compared before and after grief intervention, the effect size of the random-effect model was 0.31 (95% CI: −0.07, 0.69) showed ‘intermediate effect’, but the confidence interval was not significant. Conclusion: The grief intervention for dementia caregivers revealed a moderate effect but it was not significant. In order to prove the effectiveness of grief intervention for dementia caregivers, a meta-analysis targeting RCT studies is needed.
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Affiliation(s)
- Haewon Byeon
- Department of Medical Big Data, College of AI Convergence, Inje University, Gimhae 50834, Gyeonsangnamdo, South Korea
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19
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Chen Q, Terhorst L, Geller DA, Marsh W, Antoni M, Dew MA, Biala M, Weinstein J, Tsung A, Steel J. Trajectories and predictors of stress and depressive symptoms in spousal and intimate partner cancer caregivers. J Psychosoc Oncol 2020; 38:527-542. [PMID: 32367788 DOI: 10.1080/07347332.2020.1752879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The objective of the study is to investigate trajectories of stress and depressive symptoms of spousal and intimate partner caregivers in the context of cancer. We also examined the patient-related predictors of caregiver stress and depression. DESIGN This is a longitudinal cohort study. PARTICIPANTS Patients diagnosed with cancers affecting the hepatobiliary and pancreatic system and their spousal or intimate partner caregivers were recruited at a large tertiary cancer center. METHODS The patients and caregivers were assessed for their level of stress, depressive symptoms, relationship quality, and quality of life at the time of the patients' diagnosis, every 2 months for 12 months and then at 18 months. FINDINGS One hundred and seventy-nine caregivers were included in the trajectory analyses. Amongst the 179 caregivers, 120 patient and caregiver dyads had complete data at baseline to 6-months. The majority of the spousal caregivers were female (84%) and the mean age was 57 years. 25% of caregivers reported high levels of chronic depressive symptoms. However, significant reductions were observed at 6 months. High and moderate levels of caregiver stress were also reported in 21% and 36% of caregivers, respectively. The caregivers who reported moderate levels of stress had a decrease in stress over time while those in the high stress group reported stable levels of stress over time. Caregivers' stress is predicted by the cancer patients' depressive symptoms but not patients' quality of life. CONCLUSIONS Caregivers who reported high levels of stress and depressive symptoms at patients' cancer diagnosis remain high even after the initial adjustment. A bidirectional relationship between the caregivers' stress and the patients' depressive symptoms was observed. IMPLICATIONS The development of dyadic interventions focusing on the patients' and caregivers' distress is warranted to decrease psychological morbidities of the dyad.
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Affiliation(s)
- Qi Chen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wallis Marsh
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle Biala
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Josh Weinstein
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jennifer Steel
- Departments of Surgery, Psychiatry, and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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20
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Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief Before and After Bereavement in the Elderly: An Approach to Care. Am J Geriatr Psychiatry 2020; 28:560-569. [PMID: 32037292 DOI: 10.1016/j.jagp.2019.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses.
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Affiliation(s)
- Franziska Meichsner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt (FM), Frankfurt, Germany.
| | - Monique O'Connor
- Perth Clinic Medical Suites (MO), West Perth, Western Australia, Australia
| | - Natalia Skritskaya
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
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21
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Meichsner F, Töpfer NF, Reder M, Soellner R, Wilz G. Telephone-Based Cognitive Behavioral Intervention Improves Dementia Caregivers' Quality of Life. Am J Alzheimers Dis Other Demen 2019; 34:236-246. [PMID: 30636429 PMCID: PMC10852525 DOI: 10.1177/1533317518822100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The present study examined the effects of a telephone-based cognitive behavioral intervention on dementia caregivers' quality of life (QoL). A total of 273 caregivers were randomly assigned to an intervention or control group. The intervention comprised 12 telephone sessions of individual cognitive behavioral therapy (CBT) over 6 months. At baseline, postintervention, and 6-month follow-up, QoL was assessed with the World Health Organization QoL-BREF, which measures perceived QoL for the domains physical health, psychological health, social relationships, and environment as well as overall QoL and satisfaction with general health. Intention-to-treat analyses using latent change models were performed. At postintervention, intervention group participants reported better overall QoL and satisfaction with general health as well as better physical and psychological health compared to control group participants. Together with existing evidence, the results suggest that the telephone CBT intervention does not only reduce impairments but also fosters improvements in health-related QoL.
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Affiliation(s)
- Franziska Meichsner
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Franziska Meichsner and Nils F. Töpfer contributed equally to this work
| | - Nils F. Töpfer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Franziska Meichsner and Nils F. Töpfer contributed equally to this work
| | - Maren Reder
- Institute of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Renate Soellner
- Institute of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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22
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Abstract
Chinese family caregivers of dementia patients suffer considerable grief in their caregiving activity; little research has been conducted on dementia caregivers' grief in China. This study aims to (a) confirm the factor structure of the Mandarin version of the Marwit-Meuser Caregiver Grief Inventory-Short Form (MM-CGI-SF), (b) evaluate the levels of family caregivers' grief, and (c) explore the best predictors of family caregivers' grief. A cross-sectional study was conducted to collect data from 91 caregivers of dementia patients. The Mandarin version of the MM-CGI-SF had a three-factor structure. Family caregivers' grief was at an average level. Family caregivers' monthly household income and caring time per day predicted their own grief. The Mandarin version of the MM-CGI-SF possessed the same factor structure as the original English version, and the Chinese family caregivers experienced an average grief which was predicted by the monthly household income and caring time per day of the caregivers.
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Affiliation(s)
| | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University, China
| | - Ping Li
- Wenzhou Medical University, China
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23
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Liew TM, Tai BC, Yap P, Koh GC. Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis. Int J Geriatr Psychiatry 2019; 34:258-264. [PMID: 30370698 PMCID: PMC6635735 DOI: 10.1002/gps.5014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the person. While such phenomenon of pre-death grief (PDG) has been increasingly described, we are uncertain how it can be distinct from the well-studied construct of caregiver burden. OBJECTIVE To determine whether there are differences in the risk factors of PDG and caregiver burden to aid in our understanding of the relationship between the two constructs. METHODS Spouses or children of community-dwelling PWD were consecutively sampled from two tertiary hospitals. They completed questionnaires containing a PDG scale, a caregiver burden scale, and information related to the caregiver and PWD. Risk factors of PDG and caregiver burden were identified using multivariate regression, within which PDG and caregiver burden scores were jointly included as two separate dependent variables. RESULTS We recruited 394 caregivers with a mean age of 53.0 years (SD 10.7), majority were Chinese (86.6%), children caregivers (86.3%), and primary caregivers (70.8%). In the regression analyses, we identified three risk factors which were shared by both PDG and caregiver burden (later stage of dementia, behavioral problems in PWD, and primary caregiving role) and three other risk factors which were unique to PDG alone (younger age of PWD, lower educational attainment of caregivers, and spousal caregiver). CONCLUSIONS The different risk factor profiles evidence a distinction between PDG and caregiver burden. They may possibly be distilled into a framework to direct our approach to PDG interventions, which may include using caregiver burden as an opportunity to initiate conversations on grief, exploring the various aspects of losses and encouraging adaptive coping.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric PsychiatryInstitute of Mental HealthSingapore,Psychotherapy ServiceInstitute of Mental HealthSingapore,Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Philip Yap
- Department of Geriatric MedicineKhoo Teck Puat HospitalSingapore,Geriatric Education and Research InstituteSingapore
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24
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Liew TM, Tai BC, Yap P, Koh GCH. Comparing the Effects of Grief and Burden on Caregiver Depression in Dementia Caregiving: A Longitudinal Path Analysis over 2.5 Years. J Am Med Dir Assoc 2019; 20:977-983.e4. [PMID: 30692034 DOI: 10.1016/j.jamda.2018.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Caregivers of persons with dementia can experience loss and grief long before the death of the person. Although the phenomenon of caregiver grief has been increasingly described, it is uncertain if caregiver grief has independent effects-separate from the well-studied construct of caregiver burden-on adverse outcomes such as caregiver depression. We sought to compare the effects of baseline grief and burden on caregiver depression at baseline and 2.5 years later. DESIGN AND SETTING A cohort study with 2.5 years of follow-up. PARTICIPANTS Family caregivers of community-dwelling persons with dementia (n = 183). MEASURES Participants completed questionnaires with scales that assessed caregiver grief, burden, and depression. Baseline grief and burden scores were included in a path analysis to predict depression at baseline and at 2.5 years. RESULTS At baseline, grief and burden had synergistic relationships with each other (P = .012), where the high levels of grief amplified the effect of burden on caregiver depression. Both grief and burden had longitudinal effects on caregiver depression at 2.5 years (P <.001 and P = .047, respectively), albeit with some differences in mechanism; both had effects which were indirectly mediated through baseline depression (P < .001 and P = .002, respectively), but only grief had a direct path toward depression at 2.5 years (P = .030), which was distinct from baseline depression. CONCLUSIONS AND IMPLICATIONS The findings highlight the need to identify and address caregiver grief in dementia services. They present a window of opportunity to improve caregiving outcomes, especially during the "latent phase" when caregivers encounter loss and grief but have yet to fully experience the debilitating effects of depression.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, Singapore; Psychotherapy Service, Institute of Mental Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore; Geriatric Education and Research Institute, Singapore
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25
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Cheng ST, Au A, Losada A, Thompson LW, Gallagher-Thompson D. Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned. Curr Psychiatry Rep 2019; 21:59. [PMID: 31172302 PMCID: PMC6554248 DOI: 10.1007/s11920-019-1045-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver's ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.
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Affiliation(s)
- Sheung-Tak Cheng
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong. .,Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Alma Au
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Andrés Losada
- Psychology Department, Universidad Rey Juan Carlos, Madrid, Spain
| | - Larry W. Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA ,Betty Irene Moore School of Nursing/Family Caregiving Institute, University of California, Davis, CA 95616 USA
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Meichsner F, Theurer C, Wilz G. Acceptance and treatment effects of an internet-delivered cognitive-behavioral intervention for family caregivers of people with dementia: A randomized-controlled trial. J Clin Psychol 2018; 75:594-613. [PMID: 30597537 DOI: 10.1002/jclp.22739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/11/2018] [Accepted: 11/19/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The study evaluated the efficacy of an internet-delivered cognitive-behavioral intervention for caregivers of people with dementia and examined acceptance of program characteristics. METHOD Thirty-nine caregivers (M age = 62.11 ± 9.67, 78.4% female) were enrolled in a 2 × 3 randomized-controlled trial (RCT) that compared an intervention and wait-list control group. A cognitive-behavioral intervention program was adapted for delivery via an internet platform. Participants exchanged eight weekly messages with a therapist. RESULTS Treatment satisfaction and acceptance of the program were high. Well-being increased over the intervention duration and intervention group participants were better able to cope with the anticipated death of the care recipient and utilized more psychosocial resources after the intervention ended. Effects were not maintained until follow-up and there were no treatment effects for depression and burden of care. CONCLUSIONS Internet-delivered cognitive-behavioral interventions are suitable for caregivers. A larger RCT needs to investigate possible combinations of classic and internet-delivered programs and confirm efficacy.
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Affiliation(s)
- Franziska Meichsner
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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Cheung DSK, Ho KHM, Cheung TF, Lam SC, Tse MMY. Anticipatory grief of spousal and adult children caregivers of people with dementia. BMC Palliat Care 2018; 17:124. [PMID: 30458746 PMCID: PMC6247750 DOI: 10.1186/s12904-018-0376-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anticipatory grief (AG) among caregivers of people with dementia is common and has been found to be related to negative health outcomes. Previous studies showed different patterns of AG between spousal and adult children caregivers of people with dementia (PWD) at different stages; however, the levels of such grief are not yet compared. The findings in Western studies are very limited, and inconsistencies have also been found in Asian studies. METHODS One hundred and eight primary caregivers (54 spousal and 54 adult children) of community-dwelling PWD were recruited from elderly community services sectors in Hong Kong, China through quota sampling. The demographics, AG (measured by the Marwit-Meuser Caregiver Grief Inventory-short form), subjective caregiver burden, and well-being of the participants were assessed. A Functional Assessment Staging Test was used to grade the stages of dementia of the PWD. In this study, those in stages 4 and 5 were regarded as being at an earlier stage, and those in stages 6 and 7 at a later stage of dementia. The Mann-Whitney U-test and the Chi-square test were used to compare the variables between spousal and adult children caregivers, and the Kruskal-Wallis test was used to compare the outcomes among the sub-groups (spousal caregivers caring for relatives with earlier/later stage dementia; and adult children caregivers caring for relatives with earlier/later stage dementia). A post-hoc analysis was also conducted to identify differences between the sub-groups. Pearson's correlation was performed to investigate the bivariate relationships among AG, subjective caregiver burden, and well-being. RESULTS The results showed that spousal caregivers caring for relatives in a later stage of dementia experienced the highest level of AG and subjective caregiving burden, as compared with spousal caregivers caring for relatives in an earlier stage of dementia and adult children caregivers. Well-being was significantly negatively correlated with AG and subjective caregiver burden, while AG was also significantly correlated with subjective caregiver burden. CONCLUSION This study found that spousal caregivers of relatives in a later stage of dementia have significantly higher levels of AG, warranting special attention and extra support from palliative professionals.
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Affiliation(s)
- Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Room GH526, Hung Hom, Kowloon, Hong Kong.
| | - Ken Hok Man Ho
- School of Nursing, Tung Wah College, Room KPC 16/F, 31 Wylie Road, Homantin, Kowloon, Hong Kong
| | - Tsz Fung Cheung
- School of Nursing, The Hong Kong Polytechnic University, Room A133, Hung Hom, Kowloon, Hong Kong
| | - Simon Ching Lam
- School of Nursing, The Hong Kong Polytechnic University, Room GH523, Hung Hom, Kowloon, Hong Kong
| | - Mimi Mun Yee Tse
- School of Nursing, The Hong Kong Polytechnic University, Room FG425, Hung Hom, Kowloon, Hong Kong
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28
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Liew TM, Yap P, Luo N, Hia SB, Koh GCH, Tai BC. Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the Mandarin-Chinese version of Marwit-Meuser caregiver grief inventory. BMC Geriatr 2018; 18:114. [PMID: 29751741 PMCID: PMC5948857 DOI: 10.1186/s12877-018-0804-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 05/01/2018] [Indexed: 11/16/2022] Open
Abstract
Background Pre-death grief (PDG) is a key challenge faced by caregivers of persons with dementia (PWD). Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) are among the few empirically-developed scales that detect PDG. However, they have not had a Mandarin-Chinese version even though Chinese-speaking populations have among the largest number of PWD. We produced a Mandarin-Chinese version of MM-CGI and evaluated whether it had equivalent scores and similar psychometric properties to the English version. Methods We produced the Chinese MM-CGI through the methods of forward-backward translation and cognitive debriefing. Then, we recruited family caregivers of PWD (n = 394) to complete either the Chinese (n = 103) or English (n = 291) version. The two versions were compared in their score-difference (adjusting for potential confounders using multiple linear regression), internal-consistency reliability (using Cronbach’s α) and test-retest reliability (using intraclass correlation-coefficient), known-group validity (based on the relationship with the PWD and stage of dementia) and construct validity (using Spearman’s correlation-coefficient). Results The two versions showed similar mean scores, with the adjusted score-difference of 1.2 (90% CI -5.6 to 7.9) for MM-CGI and − 0.4 (90% CI -2.9 to 2.1) for MM-CGI-SF. The 90% CI for adjusted score-difference fell within predefined equivalence-margin (±8 for MM-CGI and ± 3 for MM-CGI-SF) and indicated equivalence of the scores. The two versions also demonstrated similar characteristics in reliability and validity. Conclusions The Chinese MM-CGI opens the way for PDG assessment and intervention among Chinese-speaking caregivers. Establishing its measurement equivalence with the English version paves the way for cross-cultural research on PDG in dementia caregiving. Electronic supplementary material The online version of this article (10.1186/s12877-018-0804-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tau Ming Liew
- Department of Geriatric Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, Singapore. .,Psychotherapy Service, Institute of Mental Health, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Soo Boon Hia
- Department of Geriatric Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Kazmer MM, Glueckauf RL, Schettini G, Ma J, Silva M. Qualitative Analysis of Faith Community Nurse-Led Cognitive-Behavioral and Spiritual Counseling for Dementia Caregivers. QUALITATIVE HEALTH RESEARCH 2018; 28:633-647. [PMID: 29169293 DOI: 10.1177/1049732317743238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.
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Affiliation(s)
| | | | | | - Jinxuan Ma
- 2 Emporia State University, Emporia, Kansas, USA
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Meichsner F, Wilz G. People who face the bereavement of a partner with dementia have poorer mental health than those whose partners are dying from other diseases. Evid Based Nurs 2017; 21:29-30. [PMID: 28882846 DOI: 10.1136/eb-2017-102716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Franziska Meichsner
- Department of Clinical Intervention and Counseling, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
| | - Gabriele Wilz
- Department of Clinical Intervention and Counseling, Friedrich Schiller University Jena, Institute of Psychology, Jena, Germany
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