Socio-demographic determinants of caregiving in older adults of low- and middle-income countries

Caregiver Challenges and Opportunities for Accessing Early Hearing Detection and Intervention: A Narrative Inquiry from South Africa

BACKGROUND

Early Hearing Detection and Intervention (EHDI) is essential for minimising the negative impact of childhood hearing loss on speech, language, and cognitive development. However, in low- and middle-income countries such as South Africa, various challenges hinder the implementation of EHDI services, leading to delayed diagnosis and intervention.

AIM

This study explores caregivers' experiences with EHDI services, identifying key challenges and facilitators affecting access and timely intervention.

METHODS

A narrative inquiry approach was used as part of a broader research initiative on family-centred EHDI. Nine caregivers of children who are deaf or hard of hearing (DHH) were purposively sampled, and data were collected through semi-structured interviews.

RESULTS

Thematic analysis revealed systemic and structural challenges, logistical and financial constraints, and caregiver-related factors that hindered access to EHDI services. Key facilitators included caregiver knowledge and advocacy, family support services such as counselling and South African Sign Language training, and high-quality audiological and educational services.

CONCLUSIONS

Findings emphasise the need for policy-driven reforms, including expanding newborn hearing screening programmes, improving financial assistance mechanisms, and increasing public awareness. Addressing these challenges and leveraging facilitators can help South Africa align with global EHDI benchmarks and improve outcomes for DHH children.

Spousal characteristics and unmet care needs: A longitudinal national study of adults aged 50 and over in England

This paper investigates unmet needs among dyads of people aged 50 and over in England. Understanding the extent and patterns of unmet needs for long-term care across different social groups is critical for understanding care-related experiences and inequalities and planning the long-term care system. Although spouses are a main source of care support, little is known about how spouses' characteristics relate to one's experience of unmet care needs. This study adopts a dyadic perspective, investigating the association between unmet care needs and spouses' characteristics, including socioeconomic status, health status and the quality of spousal relationships. Drawing on data from the English Longitudinal Study of Ageing (ELSA) (N = 3439), we matched the information of individuals who have care needs to the characteristics of their spouses and used random effects modelling to account for the longitudinal nature of the data. The results show that having a spouse with poorer functional abilities was associated with a higher risk of experiencing objective and subjective unmet needs. Men were more likely to experience objective unmet care needs if their spouses engaged in paid work, but this is not the case for women. Women faced a lower risk of subjective and objective unmet needs when having a closer relationship with their spouse, whereas this pattern was not observed among men. The findings highlight the importance of considering the interpersonal care relationships and gendered dynamics of caregiving, providing insights into designing gender-sensitive intervention programmes to better support people in care needs and their families.

Financial train, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic

Objectives

This study aims to examine the change in financial strain, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic and explore the differences in mental health outcomes by gender, race, and relationship status.

Methods

Using the 2020 National Health and Aging Trends Study COVID-19 supplement, our sample included 2026 family caregivers of older adults. Structural equation modeling was conducted.

Results

Caregivers with financial strain showed worse mental health than those with no financial strain. Female or adult children caregivers reported significantly less time walking, more financial strain, and a higher level of negative mental health outcomes compared to male or spouse caregivers; non-White caregivers reported greater positive mental health outcomes compared to White caregivers during the pandemic.

Discussion

Health professionals should consider the financial and mental health impact of COVID-19 among family caregivers when designing and delivering caregiver support programs.

Innovation

This study provides nationally representative estimates of several important health behaviors and health outcomes for caregivers of older adults during and after the COVID-19 pandemic, helping to fill the knowledge gap about the characteristics of caregivers whose health and well-being were most affected by the pandemic.

Factors associated with being an older rather than younger unpaid carer of adults with a chronic health condition: Results from a population-based cross-sectional survey in South Australia

OBJECTIVE

To examine sociodemographic characteristics and caring experiences associated with being an older rather than younger carer of an adult with a chronic health condition.

METHODS

The population-based cross-sectional South Australian Health Omnibus survey was administered in 2016. Multiple logistic regression was used to identify sociodemographic characteristics and caring experiences associated with being an older (≥65 years) versus younger (<65 years) carer of one or more adult(s) with a chronic health condition.

RESULTS

Of 988 survey respondents who self-identified as carers, 198(20%) were 65 years or over. Characteristics associated with being an older carer included having a partner, having poor physical health, being born outside Australia, have no formal qualification, living in a household of 1-2 people, have an annual household income ≤$60,000, and owning one's home. Carer experiences associated with older carer status included providing ≥40 h of care per week, perceived control over caring, and caring for someone with a neurological condition, whereas caring for someone with a mental illness, reporting poor mental health of their own, and providing personal care were inversely associated.

DISCUSSION

Interventions directed at older carers should consider the increased likelihood that they may be investing large amounts of time in caring for someone with a neurological condition, and be culturally and linguistically diverse.

Factors relating to depressive symptoms of caregivers for older care recipients in Indonesia

Objectives: Family care is a large part of an informal workforce and there are increasing unmet demands for ageing populations, particularly in low and middle-income country settings. This study investigates relationships and care requirements for older care recipients and their caregivers within the household and identifies factors relating to depressive symptoms among caregivers of older persons.Method: Data were derived from the Indonesian Family Life Survey (IFLS Wave 5). Multiple logistic regressions were used for analyses. Outcomes were Center for Epidemiologic Studies Depression Scale (CES-D score ≥10 as having moderate to severe depressive symptoms).Results: Over half of care recipients aged 50 years and over reported requiring intermediate or high-level care intensity. Primary caregivers were most often spouses for older males and adult children for older females. Factors associated with depressive symptoms among caregivers were not working (adjusted odds ratio, AOR 1.86; 95% Confidence Interval 1.19- 2.90), primary school education (AOR 5.01; 1.96-12.8), living in rural area (AOR 1.38; 1.01-1.88), and having multiple older care recipients in the household (AOR 1.98; 1.43-2.75). Having care recipients with medium or high functional limitation levels (AORs 2.27; 1.51-3.42 and 3.36; 2.00-5.63, respectively) and not receiving household co-resident support were associated with caregivers' depressive symptoms (AOR 1.32; 1.01-1.89).Conclusion: To meet the anticipated future demands for elderly care, addressing factors relating to depressive symptoms, especially amongst those not working, low education, living in rural areas could help mitigate adverse effects for caregivers. Caregivers could benefit from the provision of adequate support, including screening for depressive symptoms.

[Homecare of elderly Brazilians with functional dependency: inequalities and challenges during the first wave of the COVID-19 pandemic]

The article aims to analyze the pandemic's effect on the burden of care for elderly persons with functional dependency according to the presence of hired caregivers and socioeconomic conditions in the year 2020. Data were obtained from the ConVid - Behavior Survey of 2020. We calculated the percentage distribution and prevalence of the population living with elderly persons with functional dependency during the COVID-19 pandemic according to sex, race/color, and income. We estimated the Pearson chi-square test and prevalence ratio for the increase in household work, fitting Poisson regression models with robust variance and using 95% confidence intervals (95%CI). Among adults living with elderly individuals, 8.1% (95%CI: 7.1-9.4) had at least one elderly person with functional dependency. During the pandemic, 11.7% (95%CI: 8.5-16.0) stopped hiring third-party caregivers, which can be explained by social distancing to reduce risk of transmission and/or by the decline in families' purchasing power. Those who lost hired caregivers during the pandemic were more likely to experience an increase in the burden of care, regardless of their socioeconomic status. There was an unequal distribution of caregiving work in the population, intensified by the arrival of the COVID-19 pandemic. The heavier load of care for elderly persons with functional dependency was sharper in more socioeconomically privileged groups such as whites and those with higher income. One hypothesis is that more vulnerable groups already bore a high burden of care before the pandemic. The crisis in care has been aggravated by the dismantling of primary healthcare in Brazil, a reduction in social support for Brazilian families during the pandemic, and rising unemployment, decreasing families' capacity to hire caregivers.

Caregiving solutions in Mexican households during COVID-19 lockdown

The COVID-19 quarantine in Mexico has meant that household members spend more time inside the home, increasing the demand for direct and indirect care by minors, the elderly, chronically ill and disabled. This forced a reconfiguration of the provision of these services by household members. The aim of the document is twofold: first, to describe socioeconomic and demographic aspects of Mexican households around care activities during the quarantine and second, to estimate the determinants of the provision of care in the quarantine. The information was obtained from the Survey of Care and COVID-19 in Mexican Homes during Quarantine (SCCMHQ). The propensity score-matching technique is used as a quasi-experimental procedure to estimate the causal effects of a treatment variable (presence of minors, elderly, chronically ill, disability, or domestic service in the home) in Mexican households. The Probit model shows that age and economic dependency are determinants of caregiving for treatment groups with minors, disability and chronic disease. In addition, sex, home income, and current employment situation are significant for treatment groups with a disability, paid domestic work, and minors, respectively. A positive “net” effect of the treatment variables in the probability of care provision was also observed. Particularly, the existence of minors at home was highly effective to promote direct and indirect care. The confinement solution is characterized by a balance between genders, except in the case of households with disabilities. This shows that a cultural and functional change is possible in the distribution of care responsibilities, which can be consolidated through public policies.

Prevalence and risk factors of senile pruritus: a systematic review and meta-analysis

OBJECTIVES

To systematically assess the prevalence and risk factors for senile pruritus (SP) in the elderly (≥60 years of age).

DESIGN

A meta-analysis was used to pool the prevalence and risk factors for SP estimated from individual studies. Four subgroup analyses were conducted to explore the prevalence for SP in different age, sex, research sites and region.

SETTING, PARTICIPANTS AND MEASURES

SP reduces quality of life in the elderly, yet the worldwide prevalence is unclear. Moreover, the risk factors for SP are controversial. Data from cross-sectional studies, case-control studies, longitudinal studies and cohort studies that reported the prevalence or the risk factors for SP were collected by searching nine electronic databases up to October 2020, including Web of Science, PubMed, Embase, Cochrane Library, CINAHL, CBM, CNKI, Wanfang and VIP. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and assessed methodological quality. Data analysis was performed using Stata V.15.1 software.

RESULTS

Seventeen studies involving 28 666 participants were included. The overall pooled prevalence of SP was 21.04% (95% CI 11.37% to 32.72%). In addition, the results showed that smoking, excessive drinking and monophagism were possible risk factors for SP, with pooled ORs of 1.26 (95% CI 1.14 to 1.40), 25.03 (95% CI 18.28 to 34.25) and 1.22 (95% CI 1.12 to 1.33), respectively.

CONCLUSIONS

The overall prevalence of SP was high. Smoking, excessive drinking and monophagism were possible risk factors for SP.

PROSPERO REGISTRATION NUMBER

CRD42019143295.

Family caregivers emphasise patience and personal growth: a qualitative analysis from the Caregiving Transitions Study

Background

informal caregiving for family and friends is becoming increasingly common due to the rising prevalence of chronic conditions and a shortage of affordable care options. While the impact of caregiving on caregivers’ health is well-documented, nuances in caregivers’ experiences may not be captured in quantitative studies. We aimed to better understand caregivers’ perception of their experiences through qualitative analysis.

Methods

participants were from the Caregiving Transitions Study (CTS), which is ancillary to the REasons for Geographic and Racial Differences in Stroke Study. We analysed responses from 150 caregivers to an open-ended question at the end of the CTS telephone interview concerning additional information about their caregiving experiences. We identified main themes and examined differences by sex, condition and relationship to the care recipient.

Results

four major themes were identified: cultural/family expectations; growth opportunities; and reciprocity; stressors and challenges and recommendations. Male caregivers more often indicated that their motivation for taking on this role was their sense of duty towards family, while female caregivers focused on the challenges and burden of caregiving that they experienced. Overall, caregivers highlighted the importance of patience and the positive impact of caregiving, such as opportunities for personal growth, acquiring new skills, and finding fulfillment and gratitude.

Conclusions

family caregivers shared both positive and challenging experiences as well as the impact that these experiences had on their lives. Understanding the full spectrum of the caregiving experience will help inform how the community and the health care system can best support caregivers in their roles.

Anxiety symptoms among informal caregivers in 47 low- and middle-income countries: A cross-sectional analysis of community-based surveys

BACKGROUND

There are no multi-country studies on the association between informal caregiving and anxiety from low- and middle-income countries (LMICs). Therefore, we investigated this relationship in a large predominantly nationally representative sample from 47 LMICs.

METHODS

Cross sectional data from the World Health Survey were analyzed. Anxiety symptoms referred to severe or extreme problems with worries or anxiety in the past 30 days. Information on caregiving in the past 12 months was obtained. Multivariable logistic regression analysis adjusting for age, sex, marital status, education, household size, employment, disability, and country was conducted. Data on 237,952 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 50.8% female] were analyzed.

RESULTS

After adjustment for potential confounders, caregiving was positively associated with anxiety symptoms (OR = 1.52; 95%CI = 1.40, 1.65). Greater number of caregiving activities was associated with higher odds for anxiety symptoms dose-dependently, with the OR (95%CI) for engagement in 5 activities (vs. no caregiving) being 2.19 (1.86-2.58).

CONCLUSION

Caregiving is associated with higher odds for anxiety symptoms among adults in LMICs. Given the increasing importance of informal caregivers in long-term care provision and the fact that good health of caregivers is vital to sustain this system, interventions to address mental health of caregivers in LMICs are urgently needed.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries

PURPOSE

Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).

CONCLUSION

Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

Identifying factors causing decline in physical functionality of geriatric population

The objective of the study was to find major correlates of decline in the physical functionality of the geriatric population. The main focus was the evaluation of demographic, social, economic, and health-related factors that have a potential impact on physical functionality. A sample of 423 elderly people were selected from district Faisalabad, Pakistan by using a snowball sampling approach. Statistical analysis was performed using frequency analysis and some tests for association like chi-square, Cramer’s V, and gamma coefficient. It was observed that 42.8% of the respondents were independent in doing their all-routine work and the physical functional status decline was observed partially in 35.2% and completely in 22.0% of the respondents. Using frequency analysis and association measures, age, education, marital status, living with family, having an independent source of income, level of social network and support, having exercise routine were found to be significantly associated with functional status of elders. The study concluded that besides age and other demographic factors that cannot be controlled, the socio-economic factors can be improved to substantially reduce the decline in the physical functionality of the geriatric population.

Do European co-residential caregivers aged 50+ have an increased risk of frailty?

One important health challenge associated with ageing is frailty, which has been acknowledged as a new public health priority. However, only a few studies have explored the relationship between providing care at older ages and frailty. The main objective of this study is to assess whether there is an association between providing co-residential care and frailty, according to gender and from a European cross-sectional perspective, among the population aged 50+. Data from 17 European countries that participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) is used (N = 52,073). Multinomial logistic regressions were used to estimate caregivers' chances of frailty. The results show that the prevalence of pre-frailty and frailty differs according to the caregiver's status, gender and the European region. The highest prevalence of pre-frailty was found in the group of female caregivers from Northern countries (57.3%), and the highest prevalence of frailty was found in the group of female caregivers from Southern countries (29.3%). Providing co-residential care is positively associated with the risk of being pre-frail in women, in all European regions (Northern: OR 1.724, 95% CI 1.190-2.496; Central: OR 1.213, 95% CI 1.010-1.456; Eastern: OR 1.227, 95% CI 1.031-1.460; Southern: OR 1.343, 95% CI 1.103-1.634), and with being frail for both genders in the Southern region (female: OR 1.527, 95% CI 1.060-2.200; male: OR 1.644, 95% CI 1.250-2.164). The results of this study suggest that female co-residential caregivers are a greater risk of being pre-frail in all European regions except Southern Europe, where male and female co-residential caregivers are a greater risk of being frail, compared with non-caregivers. European policy makers should create political measures to prevent and reverse frailty among European co-residential caregivers.

Health impact of providing informal care in Portugal

BACKGROUND

Middle-aged and older adults play an important role in the provision of informal support, however, the impact on the health of those individuals who provide informal care is unclear. The main objectives of this study are: (1) to assess the prevalence of co-residential caregiving provided by individuals aged 50+; (2) to analyze differences between the group of Portuguese co-residential caregivers and the group of Portuguese non-caregivers; (3) to examine the longitudinal effect of providing informal care on the health of co-residential informal caregivers in Portugal.

METHODS

Data from wave 4 and wave 6 of the Survey of Health Ageing and Retirement in Europe (SHARE) were used. A linear mixed model and a generalized mixed model were used to analyze the longitudinal effect of providing informal care on the health (physical health and depressive symptoms) of Portuguese individuals aged 50 + .

RESULTS

In both SHARE waves analyzed, Portugal had the highest percentage of co-residential caregivers aged 50+. At baseline, the Portuguese co-residential caregiver population, compared to non-caregivers, has a lower percentage of employed individuals (14.9% compared to 25.7%) and a higher percentage of individuals with four or more depressive symptoms (56.4% compared to 35.5%). The caregivers also have a lower quality of life (CASP-12) (30.93 compared to 32.59). Marginal differences in educational levels between the caregiver and non-caregiver groups were also found, with co-residential caregivers having lower levels of education (72.3% have ISCED 0-2 compared to 64.7%), lower levels of cognitive function (- 2.321 compared to - 1.784), lower levels of physical health (- 0.180 compared to - 0.076) and lower engagement in moderate or vigorous physical activity (14.9% compared to 21.5%). Longitudinal models reveal that providing care within the household is not associated with physical health (b = 0.048; se = 0.035; p = 0.167), but is associated with depressive symptoms (OR = 1.609; 95% CI = 1.141-2.271; p = < 0.010).

CONCLUSIONS

Portugal has the highest percentage of co-residential caregivers aged 50+. In that country, providing informal care to a household member is associated with depressive symptoms. Portuguese policymakers should therefore promote programs to prevent and alleviate the depressive symptoms experienced by individuals aged 50+, who provide co-residential care.

Gender Differences in Spousal Caregivers' Care and Housework: Fact or Fiction?

OBJECTIVE

Many studies reveal a gender gap in spousal care during late life. However, this gap could be an artifact of methodological limitations (small and unrepresentative cross-sectional samples). Using a data set that overcomes these limitations, we re-examine the question of gender differences in spousal care and housework adjustment when a serious illness occurs.

METHOD

We use biannual waves between 2001 and 2015 of the German Socio-Economic Panel Study and growth curve analyses. We follow couples longitudinally (identified in the household questionnaire) to analyze shifts in spousal care hours and housework plus errand hours that occur as a response to the spousal care need. We test for interactions with levels of care need and with gender.

RESULTS

We found that men increase their care hours as much as women do, resulting in similar care hours. They also increase their housework and errand hours more than women do. Yet at lower levels of spousal care need, women still do more housework and errands because they spent more time doing housework before the illness.

DISCUSSION

Even in a context of children's decreasing availability to care for parents, male spouses assume the required caregiving role in systems relying on a mixture of public and private care.

Informal caregiving and physical activity among 204,315 adults in 38 low- and middle-income countries: A cross-sectional study

Data on the association between informal caregiving and physical activity (PA) levels are scarce, especially from low- and middle-income countries (LMICs). Furthermore, previous research has yielded conflicting results. Thus, we investigated this association in adults from 38 LMICs. Data from the World Health Survey (WHS), a cross-sectional, predominantly nationally representative survey conducted in 2002-2004, were analyzed. PA was assessed by the International Physical Activity Questionnaire and participants were dichotomized into those who do (≥150 min of moderate-to-vigorous PA per week) and do not (<150 min = low PA) comply with the World Health Organization PA recommendations. Those who provided help to a relative or friend (adult or child), because this person has a long-term physical or mental illness or disability, or is getting old and weak in the past year were considered to be informal caregivers. Multivariable logistic regression analysis was conducted to assess the associations. There were 204,315 adults aged ≥18 years from 38 LMICs included in this study [mean (standard deviation) age 38.6 (16.1) years; 50.7% female]. Overall, the prevalence of caregiving and low PA was 19.5% and 29.9%, respectively. After adjustment for potential confounders, caregivers were at a lower risk for low PA compared to non-caregivers (OR = 0.79; 95% CI = 0.72-0.86). Engagement in greater number of caregiving activities was associated with lower odds for low PA dose-dependently. Informal caregiving was associated with higher levels of PA in adults in LMICs. Future studies of longitudinal design are warranted to understand causality and the underlying mechanisms of this association.

The impact of acute adenolymphangitis in podoconiosis on caregivers: A case study in Wayu Tuka woreda, Oromia, Western Ethiopia. 'If she was healthy, I would be free.'

Background

Podoconiosis, also known as mossy foot or endemic non-filarial elephantiasis, is a preventable form of lower-leg lymphoedema caused by prolonged (typically barefoot) exposure to soil derived from volcanic rocks. Acute adenolymphangitis (also called ‘acute attack’) is a serious complication of podoconiosis resulting in significant symptoms and worsening disability. Despite the well-known morbidity associated with podoconiosis, to date there have been no studies looking at the impact, or burden, of podoconiosis on caregivers. This study explored the experiences and impact of acute attacks on the caregivers of those with podoconiosis in one endemic district of Ethiopia.

Methods/Principal findings

This qualitative study was based in Wayu Tuka woreda (district), Oromia, Western Ethiopia. 27 semi-structured interviews of those with podoconiosis and their caregivers were conducted in June 2018. Here we report the findings from the caregiver’s interviews. Data were analysed using NVivo 12. Directed content analysis, a qualitative approach related to thematic analysis, was used to analyse the results. This study highlights a previously unreported impact of acute attacks on the caregivers of those affected by podoconiosis. The findings demonstrate the significant social and financial pressures placed on podoconiosis-affected families which are exacerbated during acute attacks. This study also highlighted the emotional burden experienced by caregivers, the range of care activities placed on them and the limited support available.

Conclusions

This study found a significant impact on the caregivers of those with podoconiosis, especially during acute attacks, in Wayu Tuka woreda. It also highlighted the limited support available to caregivers. Further research is needed to understand whether this impact applies to podoconiosis caregivers across Ethiopia, and beyond, and to establish if there are wider implications of this important consequence of podoconiosis, for example on the economy and caregivers’ mental and physical health.

Podoconiosis is a foot condition, common in the highlands of Ethiopia, caused by exposure to volcanic soil. It can be prevented by wearing shoes and adhering to foot hygiene practices. Podoconiosis causes swelling of the lower legs and is a disabling and stigmatised condition. It is made worse by ‘acute attacks’, during which the leg becomes painful, swollen and red. Often the person affected cannot work and is bedbound during these episodes. This study identified a previously unreported burden on the caregivers of those with podoconiosis during acute attacks in one endemic district of rural Ethiopia. Specifically, we identified a significant social and financial pressure placed on podoconiosis-affected families in meeting healthcare costs, covering daily expenses such as children’s education costs and progressing within their communities. This study also highlighted the emotional burden experienced by caregivers, the range of care activities placed on caregivers and the limited support available. These findings warrant further research in other contexts but highlight an important wider social consequence of podoconiosis.

Cross-cultural adaptation to Brazilian Portuguese of the Dementia Knowledge Assessment Tool Version Two: DKAT2

ABSTRACT The Dementia Knowledge Assessment Tool Version Two (DKAT2) was developed to measure caregivers’ knowledge about the trajectory of dementia and assess changes in the knowledge before and after educational programs. The DKAT2 is a 21-item tool with questions about several aspects of dementia. The possible answers for each question are “yes”, “no” or “don't know”. The maximum score is 21. Objective: The aim of the study was to cross-culturally adapt the DKAT2 to Brazilian Portuguese. Methods: The essential steps to cross-culturally adapt were conducted and the final version administered to 30 caregivers of older people with dementia, sampled by convenience. Results: In the sample assessed, the mean age was 55.7 (± 12.5) years, 93.3% were female, 56.7% were sons/daughters and 23.3% were spouses of the older adults with dementia. The mean time caring for the elder was 4.7 (± 3.3) years and 70% of the caregivers had some level of burden. The mean age of the older people was 82.4 (± 6.7) years, 19 (63.3%) had a diagnosis of Alzheimer's disease, 100% were dependent for instrumental activities of daily living and 70% had some degree of dependence for basic activities of daily living. The mean score for the caregivers’ knowledge level was 15.0 (± 2.5) correct answers. Conclusions: The Brazilian Portuguese version was developed and the final version is suitable for use in Brazil.

Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers

Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.

The development and validation of the Dementia Quality of Life Scale for Older Family Carers (DQoL-OC)

PURPOSE

Little is known about how caregiving affects the quality of life (QoL) of older family carers and no dementia and age-specific QoL scale is available for use with this population. This study aimed to develop and validate a unique dementia caregiving- and age-specific tool - the 'Dementia Quality of Life Scale for Older Family Carers' (DQoL-OC).

METHODS

The scale items were identified in focus groups with older family carers in the UK. Content and face validity were evaluated by a panel of six experts. A set of 100 items assessed on a 5-point Likert scale was tested with 182 older family carers. Test-re-test reliability was conducted with 18 individuals. Exploratory factor analysis was used to identify the QoL model and reduce the number of scale items. Convergent construct validity and internal consistency were also established.

RESULTS

A one-factor solution containing 22 items was obtained. Test-re-test reliability (lower bound r = 0.835; p < 0.001), internal consistency (Cronbach's α = 0.936), and convergent construct validity were established. Significantly lower levels of QoL were found in female older carers; those who perceived their relatives with dementia as being at the earlier stages of the disease and with unstable dementia symptoms; those providing care more hours per day and more days per week; and those in younger-old age.

CONCLUSIONS

The DQoL-OC is a valid and reliable scale that will be useful for research and in clinical practice with older family carers of people with dementia. These study results will inform future health and social care aiming to improve life quality for this overlooked population of carers.

Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys

Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices.

Determinants of inappropriate acute pain management in old people unable to communicate verbally in the emergency department

Objectives

Poor pain management is relevant among individuals unable to communicate verbally (UCV). Analgesia may be due to three determinants: patients' status, physician's characteristics and pain etiology. Our aim is to investigate the association between prescription of ED pain treatment and these determinants.

Materials and Methods

An observational prospective study including UCV patients was conducted. Severity of pain was evaluated by ALGOPLUS Scale and a score P ≥ 2 out of 5 on the pain scale was retained as the threshold for the presence of acute pain in elderly UCV patients.

Results

Our data showed that only 31,9% of UCV patients received a pharmacological treatment. The presence of the caregiver would influence the rate of therapy administration [OR 6,19 (95% CI 2,6–14,75)]. The presence of leg pain [OR 0,32 (95% CI 0,12–0,86)] and head pain [OR 0,29 (95% CI 0,10–0,84)] were less likely associated to receive analgesia. Pain related to trauma [OR 4.82 (95% CI 1.17 to 19.78)] and youngest physicians [OR 1.08 (95% CI 1.001 to 1.18)] were variables associated with the administration of drugs opiates.

Discussion

Older UCV patients presenting to the ED with pain are at high risk of inadequate analgesia. Providers should always suspect presence of pain and an increasing need for behavioural pain evaluation is necessary for a complete assessment.

Conclusions

Presence of a caregiver influences a more appropriate pain management in these patients. Staff training on pain management could result in better assessment, treatment, and interaction with caregivers.

Informal caregiving as a risk factor for type 2 diabetes in individuals with favourable and unfavourable psychosocial work environments: A longitudinal multi-cohort study

AIM

To examine whether informal caregiving is associated with increased risk of type 2 diabetes (T2D), and whether job strain and social support at work modify the association.

METHODS

Individual participant's data were pooled from three cohort studies-the French GAZEL study, the Swedish Longitudinal Occupational Survey of Health (SLOSH) and the British Whitehall II study-a total of 21,243 study subjects. Informal caregiving was defined as unpaid care for a closely related person. Job strain was assessed using the demand-control model, and questions on co-worker and supervisor support were combined in a measure of social support at work. Incident T2D was ascertained using registry-based, clinically assessed and self-reported data.

RESULTS

A total of 1058 participants developed T2D during the up to 10 years of follow-up. Neither informal caregiving (OR: 1.09, 95% CI: 0.92-1.30) nor high job strain (OR: 1.04, 95% CI: 0.86-1.26) were associated with T2D risk, whereas low social support at work was a risk factor for T2D (OR: 1.18, 95% CI: 1.02-1.37). Also, informal caregivers who were also exposed to low social support at work were at higher risk of T2D (OR: 1.40, 95% CI: 1.08-1.82) compared with those who were not informal caregivers and had high social support at work (multiplicative test for interaction, P=0.04; additive test for interaction, synergy index=10).

CONCLUSION

Informal caregiving was not independently associated with T2D risk. However, low social support at work was a risk factor, and informal caregivers with low social support at work had even higher risks of T2D.

The effect of laughter therapy on the quality of life of nursing home residents

AIMS AND OBJECTIVES

To evaluate the effect of Laughter therapy on the quality of life of nursing home residents.

BACKGROUND

By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance.

DESIGN

Quasi-experimental design.

METHOD

The study was conducted between 2 March - 25 May 2015. The experimental group was composed of 32 nursing home residents from one nursing home, while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection.

RESULTS

After the laughter therapy intervention, general and subscales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and spiritual health) quality-of-life scores of residents in the experimental group significantly increased in comparison with the pretest.

CONCLUSION

Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention.

RELEVANCE TO CLINICAL PRACTICE

The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.

Prepared to care: adult attachment and filial obligation

OBJECTIVES

Past work found that close adult attachment dimension scores predict caregiver preparedness. Theory and past research suggests filial obligation (FO) may mediate the relationship between attachment and caregiver preparedness. The goal of this study was to test that hypothesis.

METHOD

The sample, collected using Mechanical Turk, included 165 women between the ages of 45 and 65 years who were not providing care to an aging parent.  Participants were reimbursed $0.75 for completing an online survey assessing response validity, dimensions of adult attachment, depressive symptomatology, FO, and caregiver preparedness, among other variables. The mean participant age was 52.2 years (SD = 5.5).

RESULTS

The sample was predominantly White/Caucasian (82.6%), and Black/African American (7.3%).  With respect to education, 14.5% completed high school or general education development (GED), 32.7% completed some college, 36.4% completed a Bachelor's degree, and 15.7% completed graduate degrees. The three attachment dimensions (close, dependent, and anxious) and FO were all significantly inner-correlated.  Stepwise multiple regression analyses found that FO fully mediates the relationship between close attachment and caregiver preparedness, even after controlling for age, education, income, depression, and birth order.

CONCLUSION

The primary finding is that FO mediates the relationship between close attachment style and caregiver preparedness among prospective caregivers. This suggests that individual differences in attachment style among prospective caregivers indirectly predict preparedness for future caregiving through FO, suggesting a mechanism relating attachment style and preparation for future care.

Unpaid Informal Caregivers in South Australia: Population Characteristics, Prevalence and Age-Period-Cohort Effects 1994-2014

BACKGROUND

The ongoing need for an availability of informal carers is taking on greater relevance as the global burden of disease transitions from acute fatal diseases to long term morbidity. Growing evidence suggests that extra burden on family carers may further impact on their health and ability to provide care. Important as it is to monitor the prevalence of those conditions which influence the burden of disease, it is also important to monitor the prevalence and health profiles of those who provide the informal care. The aim of this study was to demonstrate the prevalence and demographics of adult carers aged 15 and over in the state of South Australia over 20 years between 1994 and 2014.

METHODS

Data from nine representative, cross-sectional population surveys, conducted in South Australia, Australia were used, (total N = 26,788 and n = 1,504 carers). The adjusted prevalence estimate of carers and their demographic characteristics were determined. So as to examine whether there were any generational effects on the prevalence of carers, an Age-Period Cohort (APC) analysis was undertaken.

RESULTS

The prevalence estimates of carers increased during the two decades from 3.7% in 1994 to 6.7% by 2014. Large increases in the proportion of retired carers, those aged 70 years and over, those carers employed, and those with higher educational qualifications were observed. There were also larger proportions of respondents with a country of birth other than Australia, UK, Ireland and European counties. The APC analysis illustrated an increasing prevalence rate over each decade for carers aged 20-80 years, especially for those over the age of 60 years.

CONCLUSIONS

The results illustrate changing carer characteristics and carer prevalence estimates in South Australia as new generations of carers take on the caring role. There is a need to include questions regarding informal carers within ongoing mainstream population surveys, particularly at state levels, so as to plan for their future health care and home support.

Structural equation model linking dementia cognitive functioning, caregiver mental health, burden, and quality of informal care in Argentina

The purpose of this study was to create a path model linking cognitive functioning in individuals with dementia, caregiver burden and mental health, and quality of care provided for the individual with dementia in Argentina. One hundred and two dementia caregivers from San Lucas, Argentina completed questionnaires assessing these constructs. Regressions found that caregiver burden, depression, anxiety, and satisfaction with life explained 18.8% of the variance in quality of care-respect and 14.7% of the variance in quality of care-provide. A structural equation model with generally adequate fit indices uncovered that cognitive functioning in individuals with dementia was inversely associated with caregiver burden, caregiver burden was inversely associated with mental health, and mental health was positively associated with quality of care. Further, patient cognitive functioning yielded a significant indirect effect on caregiver mental health through caregiver burden, as did burden on quality of care through mental health. Despite this negative cascade, these relationships may also be reversed with the development and use of dementia caregiver interventions that improve caregiver burden and mental health and as a result, the quality of care for individuals with dementia in Latin America.

Health and wellbeing in informal caregivers and non-caregivers: a comparative cross-sectional study of the Swedish general population

Background

Informal caregiving by relatives is a great resource for individuals as well as for society, but the caregiving role is associated with health problems for the caregiver. This study aimed to compare caregivers’ self-rated health, number of recent days with poor health and psychological wellbeing with that of non-caregivers in a general Swedish population.

Methods

From 2004 to 2013, 90,845 Swedish people completed a postal questionnaire about their health, number of recent days with poor health during last month, psychological wellbeing and if they were performing caregiving or not. Descriptive statistics, chi-square analysis, ANOVA, logistic regressions and negative binomial regression models were used to investigate associations between being a caregiver or not and health and wellbeing. Negative binomial regression was used to assess the relation between caregiver status and recent days with poor health or functioning.

Results

Eleven percent reported having a caregiving role. Caregivers reported poorer self-rated health compered to non-caregivers, also in adjusted models; odds ratio (OR): 1.07 with a 95 % confidence interval (CI): 1.01-1.13. Caregivers also reported lower psychological wellbeing compared to non-caregivers; OR: 1.22, CI: 1.15-1.30. Caregiving status was associated with more recent days with poor physical health and more recent days with poor mental health.

Conclusions

This study suggests that caregivers have worse perceptions in self-rated health and psychological wellbeing compared with non-caregivers, indicating that the role of caregiver is adversely associated with health. This association also appears in terms of reporting days of poor health in the last month. The underlying mechanism of these associations, including the potential detrimental health effects of being a caregiver, needs to be investigated in longitudinal studies.

Informal support in Portugal by individuals aged 50

In Portugal, individuals aged 50+ have an important role in the provision of co-residential care. This study aimed to rank Portugal relative to 15 European countries with regard to the prevalence of co-residential care (daily or almost daily personal care), and extra-residential help/care (household help and/or personal care) provided by individuals aged 50+, and determine the factors associated with the provision of these types of support in the Portuguese context. The study used data from the SHARE wave 4 project (2010-2011) and was based on an analysis of variance and logistic regression models. Portugal differs from other European countries, as it has the highest rate of co-residential care (12.4 %) and the lowest rate of provision of extra-residential help/care (10.8 %). It is concluded that the quality of life (QoL) of Portuguese co-residential carers is lower than the QoL of non-carers, but extra-residential help/care provided once a month or less has a positive impact on the QoL of the providers. Co-residential care and the provision of frequent extra-residential help/care (daily or weekly) were associated with a higher number of depressive symptoms. The results further showed that, in Portugal, co-residential carers and extra-residential helpers/carers have different socio-demographic, economic and health characteristics. This study demonstrates that it is important for scientific research to differentiate the type and frequency of informal support, since this can help us design policies to meet the specific needs of the various types of informal carers aged 50+.