1
|
Sánchez-Alcón M, Garrido-Fernández A, Cano-Rojas JM, Sánchez-Ramos JL, Ramos-Pichardo JD. Relationship between Depressive Symptoms, Caregiver Strain, and Social Support with Dementia Grief in Family Caregivers. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:643. [PMID: 38674288 PMCID: PMC11052144 DOI: 10.3390/medicina60040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Dementia grief in family caregivers of people with dementia refers to grieving prior to the death of the care recipient. It is related to psychosocial risk factors that may have a negative impact on the health of these family caregivers. This study aimed to describe the relationship between depressive symptoms, caregiver strain, and social support with dementia grief in family caregivers of people with dementia. Materials and Methods: A descriptive correlational cross-sectional study was conducted. A total of 250 family caregivers of people with dementia participated. Dementia grief was the main variable, and depressive symptoms, caregiver strain, and social support were assessed. Additionally, socio-demographic data were collected. Descriptive statistics were calculated, and a bivariate correlation analysis and a multiple linear regression analysis were performed for dementia grief. Results: Higher scores for dementia grief were found in women, in family caregivers of patients at advanced stages of dementia, and in family caregivers with a low level of education. High levels of depressive symptoms and caregiver strain and low levels of social support indicated greater intensity of dementia grief. Depressive symptomatology was the variable with the greatest influence on dementia grief. Caregiver strain and social support also related to dementia grief, but to a lesser extent. Conclusions: In family caregivers, depressive symptoms, caregiver strain, and social support are related to the intensity of dementia grief, with a greater influence of depressive symptoms. Moreover, being female, having a low level of education, and caring for a care recipient at an advanced stage of dementia are factors associated with increased dementia grief. Concerning study limitations, the sample was restricted, belonging to a specific region of Spain and to a Provincial Federation of associations. It is necessary to exercise caution in generalizing results due to the sociodemographic and geographical characteristics of the sample.
Collapse
Affiliation(s)
- Miriam Sánchez-Alcón
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - Almudena Garrido-Fernández
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - José María Cano-Rojas
- Provincial Federation of Associations of Family Caregivers of People with Alzheimer’s Disease and other Dementias of Huelva and Province, 21710 Huelva, Spain;
| | - José Luis Sánchez-Ramos
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| | - Juan Diego Ramos-Pichardo
- Nursing Department, Nursing Faculty, University of Huelva, 21007 Huelva, Spain; (A.G.-F.); (J.L.S.-R.); (J.D.R.-P.)
| |
Collapse
|
2
|
Malhotra C, Chaudhry I, Shah SU. Caregivers' Burden and Anticipatory Grief Increases Acute Health Care Use in Older Adults With Severe Dementia. J Am Med Dir Assoc 2024:S1525-8610(24)00205-6. [PMID: 38599241 DOI: 10.1016/j.jamda.2024.03.001] [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: 10/02/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To assess the bidirectional association of caregivers' burden and anticipatory grief with acute health care use (inpatient or emergency admission) among older adults with severe dementia. DESIGN Prospective cohort. SETTING AND PARTICIPANTS A total of 215 family caregivers of older adults with severe dementia in Singapore were surveyed every 4 months for 3 years (up to 10 surveys). We measured caregiver burden using the Caregiver Reaction Assessment scale and anticipatory grief using the Marwit Meuser Caregiver Grief Inventory-Short Form. METHODS Using separate multivariable mixed-effects logistic regressions, controlling for relevant confounders, we assessed the association of caregiver burden and anticipatory grief (independent variables measured at time t) with older adults' acute health care use in the next 4 months (outcome measured at time t + 1). We also performed separate multivariable mixed-effects linear regressions to assess the association of older adults' acute health care use in the past 4 months (independent variable measured at time t) with caregiver burden and anticipatory grief (outcomes measured at time t). RESULTS At baseline, 33% of the older adults had an inpatient or emergency admission in the past 4 months. Regression results showed that higher caregiver burden (odds ratio [OR], 1.58; 95% CI, 1.15-2.16) and anticipatory grief (OR, 1.02; 95% CI, 1.00-1.04) significantly increased the likelihood of older adults experiencing acute health care use in the next 4 months. However, older adults' acute health care use in the past 4 months did not significantly change their caregivers' burden or anticipatory grief. CONCLUSIONS AND IMPLICATIONS Higher caregiver burden and anticipatory grief increase the likelihood of older adults having acute health care use. Addressing caregivers' well-being has implications for reducing acute health care use in older adults and the economic burden of severe dementia.
Collapse
Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | |
Collapse
|
3
|
Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. DEATH STUDIES 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
Collapse
Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| |
Collapse
|
4
|
Bauernschmidt D, Wittmann J, Hirt J, Meyer G, Bieber A. The Implementation Success of Technology-Based Counseling in Dementia Care: Scoping Review. JMIR Aging 2024; 7:e51544. [PMID: 38271050 PMCID: PMC10853855 DOI: 10.2196/51544] [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: 08/03/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Implementing technology-based counseling as a complex intervention in dementia care poses challenges such as adaptation to stakeholders' needs and limited resources. While studies have examined the effectiveness of technology-based counseling, its successful implementation remains largely unexplored. OBJECTIVE We aimed to review the knowledge about the implementation success of technology-based counseling interventions for people with dementia and their informal caregivers. METHODS We conducted a scoping review and systematically searched CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science Core Collection databases (April 2021) in combination with citation searching and web searching (November 2021). Studies reporting on technology-based counseling interventions for people with dementia or their informal caregivers were included, irrespective of the design. We used the conceptual framework for implementation outcomes to operationalize implementation success and applied the outcomes acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability as categories to inform data extraction. We identified dimensions within the categories and synthesized results narratively and graphically. RESULTS We included 52 publications reporting on 27 technology-based counseling interventions. The studies were conducted in 9 countries and published between 1993 and 2021. As the design of the included studies varied, the number of participants and the type of data reported varied as well. The intervention programs were heterogeneous and ranged from single counseling interventions (such as helpline services) to counseling as part of a multicomponent program. Telephone, email, videoconferencing, social media (respectively chats), and web-based platforms were used for delivering counseling. We found data on appropriateness for all interventions and data on acceptability for most interventions, describing aspects such as consumer-perceived usefulness and helpfulness of services, as well as satisfaction. Information on the other categories of adoption, feasibility, fidelity, implementation cost, penetration, and sustainability was fragmented. CONCLUSIONS The scope and depth of information on conceptual categories of the implementation success of technology-based counseling for people with dementia and informal caregivers varied. The data only partially covered the concept of implementation success, which highlights the need for a systematic evaluation accompanying the implementation. The application of theoretical approaches for implementation and adherence to the framework for developing and evaluating complex interventions are required to promote the implementation of complex interventions and to comprehensively assess implementation success. TRIAL REGISTRATION PROSPERO CRD42021245473; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=245473.
Collapse
Affiliation(s)
- Dorothee Bauernschmidt
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Janina Wittmann
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Center for Dementia Care, Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabriele Meyer
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
5
|
Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Burden and anticipatory grief in caregivers of family members with Alzheimer's disease and other dementias. Palliat Support Care 2023:1-11. [PMID: 37795789 DOI: 10.1017/s1478951523001360] [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: 10/06/2023]
Abstract
OBJECTIVES This study aimed to analyze the different factors that intervene in the task of caring for relatives of people with Alzheimer's and other dementias. A first objective focused on assessing the relation between burden and anticipatory grief, considering the possibility of social support and the risk of psychopathology. A second objective aimed to examine whether caregiver burden modulates the relationships between anticipatory grief and psychopathology. A cross-sectional design was employed. METHODS The sample consists of 129 participants who care for a family member with Alzheimer's and other dementias. A protocol based on a battery of tests has been applied and a mediation analysis was carried out. RESULTS The results show a positive relationship between burden and anticipatory grief. Social support could have an indirect relationship with anticipatory grief, based on its effect on the level of psychopathology and caregiver burden. Finally, a modulation model reflects that the relationship between anticipatory grief and psychopathology is strong, the latter having a greater effect as a result variable than as a risk variable. However, it seems that the relationship between grief and psychopathology is better explained directly than not through the modulating effect of the caregiver burden. SIGNIFICANCE OF RESULTS The results obtained encourage us to think that an approach focused on intervening in the anticipatory grief may be an opportunity to reduce or buffer other caregiving outcomes, especially those related to the perception of caregiver burden and psychopathology.
Collapse
Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Leng M, Sun Y, Li C, Han S, Wang Z. Usability Evaluation of a Knowledge Graph-Based Dementia Care Intelligent Recommender System: Mixed Methods Study. J Med Internet Res 2023; 25:e45788. [PMID: 37751241 PMCID: PMC10565620 DOI: 10.2196/45788] [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: 01/17/2023] [Revised: 04/21/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Knowledge graph-based recommender systems offer the possibility of meeting the personalized needs of people with dementia and their caregivers. However, the usability of such a recommender system remains unknown. OBJECTIVE This study aimed to evaluate the usability of a knowledge graph-based dementia care intelligent recommender system (DCIRS). METHODS We used a convergent mixed methods design to conduct the usability evaluation, including the collection of quantitative and qualitative data. Participants were recruited through social media advertisements. After 2 weeks of DCIRS use, feedback was collected with the Computer System Usability Questionnaire and semistructured interviews. Descriptive statistics were used to describe sociodemographic characteristics and questionnaire scores. Qualitative data were analyzed systematically using inductive thematic analysis. RESULTS A total of 56 caregivers were recruited. Quantitative data suggested that the DCIRS was easy for caregivers to use, and the mean questionnaire score was 2.14. Qualitative data showed that caregivers generally believed that the content of the DCIRS was professional, easy to understand, and instructive, and could meet users' personalized needs; they were willing to continue to use it. However, the DCIRS also had some shortcomings. Functions that enable interactions between professionals and caregivers and that provide caregiver support and resource recommendations might be added to improve the system's usability. CONCLUSIONS The recommender system provides a solution to meet the personalized needs of people with dementia and their caregivers and has the potential to substantially improve health outcomes. The next step will be to optimize and update the recommender system based on caregivers' suggestions and evaluate the effect of the application.
Collapse
Affiliation(s)
- Minmin Leng
- Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Nursing, Peking University, Beijing, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ce Li
- Department of Cardiac Adult Postoperative Surgical Recovery Room, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
7
|
Bauernschmidt D, Hirt J, Langer G, Meyer G, Unverzagt S, Wilde F, Wittmann J, Bieber A. Technology-Based Counselling for People with Dementia and Their Informal Carers: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2023:JAD221194. [PMID: 37125549 DOI: 10.3233/jad-221194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Information technology can enhance timely and individual support for people with Alzheimer's disease and other dementias and their informal carers. OBJECTIVE To review the effectiveness of technology-based counselling interventions for people with dementia and informal carers. METHODS Randomized controlled trials of remote dementia counselling interventions were included. We searched CINAHL, Cochrane Library, MEDLINE, PsycINFO, and the Web of Science Core Collection (April 2021) in combination with citation tracking and free web searching (October to November 2021). We provide meta-analyses for caregiver depression, burden, and self-efficacy/mastery and structured reporting for other outcomes. The Grading of Recommendations Assessment, Development and Evaluation approach and the Risk of Bias 2 tool were applied. RESULTS We included five randomized controlled trials involving 880 participants. Interventions were provided for carers (four studies) or dyads (one study). Carers were predominantly women and were the spouses or children of people with dementia. Counselling was delivered via telephone or videoconference with two to 23 sessions over 1 to 12 months. Control groups received educational and resource materials only, standard (helpline) services, non-directive support, or home visits. Meta-analysis for our primary outcome, depressive symptoms in carers, revealed no statistically significant effect (SMD -0.15; 95% CI -0.40 to 0.10). There were also no significant effects on burden and self-efficacy/mastery. We rated the certainty of evidence as low to very low and all outcomes at an overall high risk of bias. CONCLUSION The effectiveness of technology-based counselling interventions for people with dementia and informal carers remains uncertain. Theory-based approaches are needed for the development and evaluation of these interventions.
Collapse
Affiliation(s)
- Dorothee Bauernschmidt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Department of Health, Center for Dementia Care, Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gero Langer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Fabian Wilde
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Janina Wittmann
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|