Reduced employment in caregivers of frail elders: impact of ethnicity, patient clinical characteristics, and caregiver characteristics

Caregiving outcomes among informal caregivers of persons with multimorbidity and dementia: a scoping review

PURPOSE

An emerging field of research involves caregiving outcomes for persons with Alzheimer's disease and related dementias (ADRD) and co-occurring multimorbidity (ADRD-multimorbidity). This scoping review aims to assess and synthesize the body of literature on caregiving outcomes among informal caregivers of individuals with ADRD-multimorbidity.

METHODS

We adhered to the scoping review framework by Arksey and O'Malley (2005) and Levac and colleagues (2010), which encompassed five steps: (1) identify the research question(s), delineate the inclusion and exclusion criteria, (2) search for relevant studies, (3) select studies, (4) chart the data, and (5) collate, summarize, and report results. Electronic databases including Ovid Medline, CINAHL, Embase, and PsycINFO were employed to identify relevant studies.

RESULTS

A total of 1,856 articles were identified and 29 were included in the final review. The majority of studies were quantitative, cross-sectional studies. The two most commonly examined caregiving outcomes were caregiver burden and psychological well-being. Most research on caregiver outcomes treated care recipients' cognitive impairment and chronic conditions separately, rather than exploring their interaction. Most studies examining caregiver burden utilized Zarit Burden Index and its variants. Specific psychological well-being outcomes displayed great variability across studies.

CONCLUSION

Despite challenges in synthesizing the extensive variability in the way cognitive status, ADRD-multimorbidity, and caregiving outcomes were measured, included, and reported, this review underscores the intricate challenges of caregiving, especially when dealing with both cognitive impairments and co-occurring chronic conditions. This complexity underscores the need for a deeper understanding of the diverse needs facing caregivers of people with ADRD-multimorbidity.

Caregivers' Absenteeism and Its Association With Health Shocks and Functional Impairment Among Persons With Severe Dementia

Adult child caregivers of persons with severe dementia (PWSDs) experience absenteeism due to caregiving. We quantified employed adult child caregivers' absenteeism; its association with PWSDs' functional impairment and health shocks; and characteristics of caregivers not experiencing absenteeism in the presence of PWSDs' health shocks and high functional impairment. We used a prospective cohort of 111 employed adult child caregivers of community-dwelling PWSDs in Singapore surveyed every 4 months for 1 year. We calculated absenteeism days due to caregiving and the corresponding absenteeism cost. Findings showed that 43% of the caregivers experienced absenteeism due to caregiving at least once during 1 year. On average, in a month, caregivers experienced 2.3 (SD = 5.9) absenteeism days and S$758 (SD = 2120) absenteeism cost. Those caring for PWSDs with high functional impairment experienced an additional 2.5 absenteeism days and S$788 absenteeism cost versus caregivers of PWSDs with low functional impairment. Caregivers whose PWSDs experienced a health shock experienced an additional 1.8 absenteeism days and S$772 absenteeism cost versus caregivers of PWSDs without a health shock. Co-residence with PWSDs worsened the impact of PSWDs' high functional impairment on caregivers absenteeism. Caregivers not co-residing with PWSDs and not using a maladaptive coping style were less likely to experience absenteeism when caring for PWSDs with a health shock. Results suggest a need to support caregivers of PWSDs to better cope with their caregiving in order to mitigate caregivers' absenteeism.

[Reconciling Employment and Informal Caregiving for an Elderly Person at Home: Factors Influencing a Reduction in Employment due to Caregiving and Work-Related Wishes of Informal Caregivers]

OBJECTIVE

Reconciling informal caregiving and gainful employment is a challenge for many informal caregivers. The goals of this paper are to identify factors influencing care-related employment reduction, and to record work-related wishes for improving the compatibility of informal caregiving and being employed.

METHODS

Analyses were based on the cross-sectional Benefits of Being a Caregiver Study of 426 employed caregivers of an older person in need of care. Data were collected on characteristics of the care receivers and caregivers, and aspects of the caregiving and employment situation. Potential influencing factors of care-related employment reduction (n=426) were analyzed using binary logistic regression. The wishes regarding the compatibility of informal care at home and employment were examined descriptively using structured content analysis according to Mayring.

RESULTS

One quarter of the employed informal caregivers (n=108) reduced their hours of employment due to the demands of caregiving. The profile of influencing factors of a care-related employment reduction was composed of a higher number of working hours, higher effort for activities of daily living, and co-residence with the care receiver. Employed caregivers primarily expressed a desire for flexibility in working hours, a reduction in working hours, and some concessions with regard to absenteeism.

CONCLUSIONS

Relieving the burden on caregivers in the activities of daily living in form of formal and informal support services can probably reduce the likelihood of a care-related reduction in gainful employment.

Health equity and wellbeing among older people’s caregivers in New Zealand during COVID-19: Protocol for a qualitative study

Background

Knowledge of the challenges unpaid caregivers faced providing care to older people during the COVID-19 pandemic is limited. Challenges may be especially pronounced for those experiencing inequitable access to health and social care. This participatory action research study, located in New Zealand, has four main objectives, (i) to understand the challenges and rewards associated with caregiving to older care recipients during the COVID-19 pandemic restrictions; (ii) to map and collate resources developed (or mobilised) by organisations during the pandemic; (iii) to co-produce policy recommendations, identify useful caregiver resources and practices, prioritise unmet needs (challenges); and, (iv) to use project results in knowledge translation, in order to improve caregivers access to resources, and raise the profile and recognition of caregivers contribution to society.

Methods and analysis

Māori, Pacific and rural-dwelling caregivers to 30 older care-recipients, and 30 representatives from organisations supporting caregivers in New Zealand will be interviewed. Combining data from the interviews and caregivers letters (from an archive of older people’s pandemic experiences), framework analysis will be used to examine the interrelated systems of the human ecological model and the impact on caregiving experiences during the pandemic. Resources that service providers had created or used for caregivers and older people will be collated and categorised. Through co-production with caregivers and community partners we will produce three short films describing caregivers’ pandemic experiences; identify a suite of resources for caregivers to use in future events requiring self-isolation, and in everyday life; and generate ideas to address unresolved issues.

The Role of National Paid Family and Medical Leave Policies in Promoting Health Equity for Older Adults and Their Caregivers

More than 48 million unpaid family/friend caregivers in the United States provide care to older adults. This unpaid workforce provides essential support for family members or friends who have a serious, long-term illness or disability. However, family caregivers are often under supported, which contributes to negative health, economic, and psychological consequences. Despite the significant contributions of family caregivers, there are limited policy supports aimed at alleviating the hardships of care on this growing community. National paid family and medical leave policy in particular holds substantial potential to alleviate the compounding burdens faced by family caregivers and address systemic inequities that contribute to disproportionately poorer caregiving outcomes among historically marginalized older adults and their caregivers. The purpose of the current article is to provide an overview of the economic burdens and caregiving-related health disparities experienced by Black/African American and Hispanic/Latinx family caregivers and discuss the impact of paid leave policies on the overall health and well-being of older adults. We propose a "Call to Action" for gerontological nurses to work in partnership with transdisciplinary colleagues, stakeholders, and advocates to ensure all family care-givers have access to paid leave. [Journal of Gerontological Nursing, 48(3), 5-10.].

'Walk a mile in my shoes:' African American caregiver perceptions of caregiving and self-care

African American Alzheimer's disease and related dementia (ADRD) family caregivers are understudied in intervention research with discrepant evidence existing on their mental and physical health outcomes. The stress toll of ADRD caregiving, coupled with the well-documented health disparities for African Americans, place these caregivers at higher risk for morbidity and mortality.Objectives: The purpose of this study was to explore African American ADRD family caregivers' perceptions of caregiving and self-care.Design: Qualitative descriptive study based on individual, one-time, semi-structured interviews from a purposeful sample of current/former African American ADRD community-dwelling family caregivers. Participants agreed to either face-to-face or telephonic interviews between 60 and 90 minutes in length.Results: Twenty-one caregiver interviews were conducted with primarily adult children (mean age = 62.61 (SD = 12.88); 81% completed college; 57% women). Content analysis yielded three major themes: Stressors, Resources, and Coping. The results demonstrate a complex interaction of sociocultural and environmental stressors and perceptions of resources that influence the coping strategies adopted by caregivers to navigate their caregiving experience.Conclusions: These findings suggest a broadened perspective to further inform the development and testing of interventions to address the health outcomes and caregiving needs of African American ADRD caregivers.

The Israel Registry for Alzheimer's Prevention (IRAP) Study: Design and Baseline Characteristics

BACKGROUND

Family history of Alzheimer's disease (AD) is associated with increased dementia-risk.

OBJECTIVE

The Israel Registry for Alzheimer's Prevention (IRAP) is a prospective longitudinal study of asymptomatic middle-aged offspring of AD patients (family history positive; FH+) and controls (whose parents have aged without dementia; FH-) aimed to unravel the contribution of midlife factors to future cognitive decline and dementia. Here we present the study design, methods, and baseline characteristics.

METHODS

Participants are members of the Maccabi Health Services, 40-65 years of age, with exquisitely detailed laboratory, medical diagnoses and medication data available in the Maccabi electronic medical records since 1998. Data collected through IRAP include genetic, sociodemographic, cognitive, brain imaging, lifestyle, and health-related characteristics at baseline and every three years thereafter.

RESULTS

Currently IRAP has 483 participants [mean age 54.95 (SD = 6.68) and 64.8% (n = 313) women], 379 (78.5%) FH+, and 104 (21.5%) FH-. Compared to FH-, FH+ participants were younger (p = 0.011), more often males (p = 0.003) and with a higher prevalence of the APOE E4 allele carriers (32.9% FH+, 22% FH-; p = 0.040). Adjusting for age, sex, and education, FH+ performed worse than FH-in global cognition (p = 0.027) and episodic memory (p = 0.022).

CONCLUSION

Lower cognitive scores and higher rates of the APOE E4 allele carriers among the FH+ group suggest that FH ascertainment is good. The combination of long-term historical health-related data available through Maccabi with the multifactorial information collected through IRAP will potentially enable development of dementia-prevention strategies already in midlife, a critical period in terms of risk factor exposure and initiation of AD-neuropathology.

Multilevel Factors Associated with Frailty among the Rural Elderly in Korea Based on the Ecological Model

Frailty is prevalent in the rural elderly and, as a result, they are vulnerable to serious health problems. The purpose of this study was to examine the multilevel factors affecting frailty among the rural elderly using the ecological model. A total of 386 participants aged 65 years or older from 60 rural areas were included in the study. Frailty was measured using the Cardiovascular Health Study frailty index. Multilevel logistic regression analysis was used to identify the factors affecting frailty among the rural elderly. The results show that the levels of prevalence for robust, pre-frailty, and frailty groups were 81 (21%), 216 (56%), and 89 (23%), respectively. As for intrapersonal factors, old age, lower than middle school education, low and moderate levels of physical activity, depressive symptoms, and cognitive dysfunction significantly increased the risk of frailty; however, no interpersonal and community factors were significant in affecting frailty. The findings indicate that individualized strategies to encourage physical activity, prevent depressive symptoms, and preserve cognitive function are needed to prevent frailty in the rural elderly.

Reliability and validity of the Japanese version of the Caregiving Interface Work Scale in employed Japanese family caregivers

AIM

This study aimed to develop a Japanese version of the Caregiving Interface Work Scale (J-CIWS) for use with employed Japanese family caregivers.

METHODS

Permission was obtained from the developer of the original CIWS. The CIWS contains 20 items: 10 measuring care interface work (CIW) and 10 measuring work interface care (WIC). Responses are measured on a five-point Likert scale. The J-CIWS was developed through forward- and back-translation and cognitive interviews of employed family caregivers. An internet survey was conducted with 116 employed family caregivers, and 78 participants answered a retest. Questionnaire items included the J-CIWS and demographic factors. Factor analysis was conducted to determine the J-CIWS factor structure. Validity was assessed based on known-groups, convergent and discriminant validity. Internal consistency was examined by calculating Cronbach's α. Test-retest reliability was examined by calculating the Pearson's correlation coefficient.

RESULTS

The mean participant age was 50.3 years; 74 (63.8%) were male. The average weekly working and caregiving hours were 41.6 and 12.1 h, respectively. Confirmatory factor analysis supported the original two-factor model. High internal consistency (Cronbach's alpha >0.90) and sufficient test-retest reliability (weighted κ score >0.45) were demonstrated for both subscales. Convergent and discriminant validity were acceptable for the two subscales (CIW and WIC).

CONCLUSIONS

This study confirmed the usefulness of the CIWS within a Japanese context. The J-CIWS may be useful for evaluating the extent of the conflict between work and care among employed family caregivers. Geriatr Gerontol Int 2021; 21: 254-261.

Employment adjustment and mental health of employed family caregivers in Canada

Family caregivers make employment adjustment to fulfill caregiving responsibility. However, the studies on the family caregivers' mental health outcomes associated with their employment adjustment are limited. This study utilized the role theory and stress process model of caregiving to examine the relationship between employment adjustment and mental health outcomes among family caregivers, and to test family-to-work role conflict as a mediator and workplace support as a moderator in this relationship. Data (n = 1,696) were drawn from the 2012 Canada General Social Survey: Caregiving and Care Receiving. Findings suggest that employment adjustment is significantly associated with negative mental health outcomes including worse self-rated mental health and higher life stress level. In addition, family-to-work role conflict mediates between employment adjustment and mental health outcomes, with the mediating effect as significant at all levels of workplace support and as weak with increasing workplace support. The findings highlight the role of family-to-work role conflict in understanding the influence of employment adjustment on family caregiver's mental health, and the implication of workplace support on promoting caregiver-friendly workplace culture to alleviate family-to-work role conflict thereby resulting in better mental health outcomes.

Employment changes among Chinese family caregivers of long-term cancer survivors

Background

Family caregivers (FCGs) play a key role in the plan of care provision for long-term cancer survivors, yet few studies have been conducted on the impact of long-term caregiving on FCGs and their employment patterns. This study aims to further our understanding of the effect that caregiving role has on FCGs by identifying what cancer-related characteristics influence reduction of employment hours among FCGs in the post-treatment phase in China.

Methods

A total of 1155 cancer survivors participated in this study. Patients reported changes in the employment patterns of their FCGs. Descriptive analysis looked at demographic and cancer-related characteristics of cancer survivors and types of FCGs’ employment changes in both primary- and post-treatment phases. Chi-square test was used to statistically test the association between survivors’ characteristics and changes in FCGs’ hours of labor force work in post-treatment phase. Separate multivariable logistic regression models were used to examine the relationship between cancer-related characteristics of participants and employment reduction patterns among FCGs in post-treatment phase while controlling for demographic factors.

Results

In the primary-treatment phase, 45.6% of all FCGs reduced their working hours and 17.4% stopped working altogether. In the post-treatment phase, 25.2% of FCGs worked fewer hours and 6.6% left the workforce completely. The results show that a higher probability of change in employment hours among FCGs is associated with the following patient characteristics: having comorbidities, receiving chemotherapy treatment, limited ability to perform physical tasks, limited ability to perform mental tasks, and diagnosis of stage II of cancer.

Conclusions

Care for cancer patients in both primary- and post- treatment phases may have substantial impacts on hours of formal employment of Chinese FCGs. Interventions helping FCGs balance caregiving duties with labor force work are warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09922-9.

Transitions in Labour Force Participation over the Palliative Care Trajectory

BACKGROUND

Home-based palliative programs rely on family caregivers, who often miss time from employment. This article identified changes in caregivers' labour force participation over the palliative trajectory.

METHODS

Family caregivers (n = 262) were interviewed biweekly to measure transitions across four employment categories.

RESULTS

More than half of the caregivers had one employment transition and 29% had three or more. The highest proportion of transitions occurred for caregivers who were employed part-time.

INTERPRETATION

Understanding these transitions is critical to the development of strategies tailored to caregivers to contain labour force losses and to support caregivers during a time of high caregiving demands.

Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus

BACKGROUND

The short- and long-term impact of cerebrospinal fluid shunting on quality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood.

OBJECTIVE

To investigate QoL in shunted INPH patients compared to the population and to investigate which factors influence QoL in INPH.

METHODS

INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Included participants were the following: 176 INPH patients and 368 controls. QoL was assessed using the EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL and health status in 5 dimensions. Independency (accommodation and/or need for in-home care) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery (mean follow-up time: 21 mo).

RESULTS

Shunting improved QoL (P < .001) and health status in all dimensions (P < .005). Shunted INPH patients had lower QoL than controls (P < .001). The patients' health status in mobility, self-care, daily activities, and anxiety/depression was worse than the controls both before and after surgery (P < .001). The main predictors of low QoL in INPH were symptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPH patients than controls lived independently (45% vs 85%, P < .001). Time after shunting had no influence on QoL.

CONCLUSION

QoL remains improved in shunted INPH patients at a mean follow-up time of 21 mo, but the patients do not reach the same QoL as the population. Symptoms of depression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

The Effect of Medicaid Expansion on Caregiver's Quality of Life

Medicaid expansion has been shown to improve access to care, health, and finances in general populations. Until now no studies have considered how Medicaid expansion may affect informal family caregivers who are the backbone of the long term supports and services infrastructure. Family caregivers provide substantial cost savings to Medicare and Medicaid. Yet, they sustain financial, physical, and mental health strain from their caregiving role which Medicaid expansion may offset. This study evaluated the impact of Medicaid expansion on caregivers' mental health using 2015-2018 data from the Behavioral Risk Factor Surveillance System. After adjusting for demographics, socioeconomic status, and health behaviors, caregivers in Medicaid expansion states had a significantly fewer number of poor mental health days in the previous month than caregivers in non-expansion states (ß = -0.528, CI -1.019, -0.036, p < .01). Study findings indicate that Medicaid expansion state status was protective for caregiver's mental health.

Factors related to adverse mental health condition of demented family caregivers: A study in West Bengal, India

Dementia caregiving is a unique and the caregivers faces extreme challenges which affect care-giver’s mental health adversely. Family caregiving towards elderly individuals with dementia is becoming widespread. The study aims to evaluate the mental health status of dementia family caregivers and some related factors that affect their mental health condition.

Present cross sectional study includes a total of 134 family caregivers. Socio-demographic and caregiving related data were collected using pre-tested questionnaires. Standardized questionnaires were used to collect data on caregivers’ mental health traits (measured in terms of level of stress and anxiety), level of psychosocial distress, support they provided and the care recipient’s behavioural symptoms associated with dementia. Mean age of the caregivers was 61.64 years (SD 13.89) while the care recipients were above 70 years of age. Mean age of care recipients was 75.46±7.26 years. Alzheimer’s type of dementia was the most common type found among them. Higher level of stress and anxiety was prevalent among the caregivers. Level of education, being a spouse, psychological distress has strong relationship with caregivers’ mental health condition. Behavioural abnormalities of care recipients were also responsible for poor mental health conditions of caregivers. Family caregiving is becoming the most suitable option nowadays and it associated with caregivers’ psychological distress and other health issues. Present study also revealed distressed mental health conditions of caregivers. Since care recipients remain dependent mostly on their family care-givers, it is necessary that caregivers should be fit mentally as well as physically. Therefore, proper support and management is needed for caregivers in near future.

Dementia care-giving and employment: a mixed-studies review on a presumed conflict

Many persons with dementia live at home and are cared for by their relatives. If the relatives are still employed, this can lead to higher burden and losses in their work-life. The interplay between informal care-giving and working is complex. Different studies have explored this issue, but the results have not been yet synthesised. In this mixed-studies review, we elucidate the underlying complexity. Our objective is to identify the factors related to care-giving that influence employment, and to describe their impact on dementia care-givers’ employment. We performed a literature search of primary studies using four databases and one meta-database, and retrieved English- and German-language articles. We used the Mixed Methods Appraisal Tool to assess their methodological quality. Evidence identified was synthesised by a parallel-results convergent synthesis design. We included 55 qualitative, quantitative and mixed-method studies published up to January 2018. The emerging model identified factors linked to the care recipient with dementia, the informal care-giver and the care-giving context. The impacts of these factors on care-givers’ employment are mostly negative (e.g. stopped/reduced work, decreased job performance). Nevertheless, the results provide encouraging insights as working can counterbalance care-giving strain, and managing both roles can enhance care-givers’ wellbeing. Practical efforts should focus on enabling informal care-givers to better manage the balance between care-giving and work responsibilities.

Exploring how workplace and social policies relate to caregivers' financial strain

Informal caregiving is a critical component of the US long-term care system, but can have significant negative impacts on caregiver employment, finances, and well-being. An online survey of Colorado caregivers was piloted in 2016-17 to explore whether workplace and social policies such as access to paid family leave and public health insurance can buffer the negative financial impacts of caregiving and help caregivers to remain in the workforce. Using standardized measures, the survey assessed caregivers' employment and financial status, well-being (physical and mental health, caregiver strain, benefits of caregiving), access to workplace supports, and covariates (e.g., caregiver demographics, health, social support, and service utilization). Ninety-five caregivers, recruited through community agency partners, completed the survey. Respondents were predominately female (89%), middle-aged (M = 57), non-Hispanic White (64%) or Latino/a (22%), and caring for a parent (40%) or spouse (30%) for over one year. Half (51%) reported working full- or part-time jobs, while 16.4% had stopped working because of caregiving. In multivariate regression modeling, predictors of financial strain included the care recipients' financial strain and the caregiver's reduction or ceasing of work. Medicare may be protective to minimize caregivers' need to reduce or cease work. Implications for caregivers' ability to stay engaged in the workforce and prepare for their own retirement are explored.

Diabetes-related behaviours among elderly people with pre-diabetes in rural communities of Hunan, China: a cross-sectional study

OBJECTIVE

To explore diabetes-related behaviours and their influencing factors among elderly individuals with pre-diabetes in rural areas of China.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional survey was conducted among elderly individuals (≥60 years) in rural communities in Yiyang City of China. Multistaged cluster random sampling was carried out to select 42 areas, and interviews were conducted among 434 elderly individuals with pre-diabetes (fasting plasma glucose 6.1-7.0 mmol/L and/or 2-hour post-glucose load of 7.8-11.1 mmol/L) using questionnaires on diabetes-related behaviours. The diabetes-related behaviours included eight categories: average daily sedentary time; frequency of physical activities per week; regular or irregular diet; whether paying attention to diet control or not; daily dietary preferences; frequency of physical examinations per year; current smoking status; and current consumption of alcohol. Each of the risky behaviours was scored -1 and each of the healthy behaviours was scored +1. Each individual's score of diabetes-related behaviours was the sum of the score for all behaviours.

MAIN OUTCOME MEASURES

Participants were asked about general information (age, gender, marital status, history of hyperglycaemia, family history of diabetes mellitus, presence of other diseases, body mass index, waist-to-hip ratio and education) and their diabetes-related behaviours. Multivariate linear regression analysis was performed to identify the risk factors for diabetes-related behaviour among elderly individuals with pre-diabetes.

RESULTS

The average score of diabetes-related behaviours of elderly individuals with pre-diabetes in rural China was 2.7. The prevalences of risky diabetes-related behaviours were as follows: <1 physical examination per year (57.6%), insufficient physical activities (55.3%), lack of attention paid to diet control (51.4%), high-salt and high-fat diets (41.0%), sedentary lifestyle (35.9%), smoking (22.8%), regular alcohol uptake (15.0%) and irregular diet (3.9%). Gender and a history of hyperglycaemia were found to be influencing factors of the diabetes-related behaviour score.

CONCLUSIONS

The prevalence of risky diabetes-related behaviours was high among pre-diabetic elderly individuals in rural China. More effort should be made to promote the prevention and control of diabetes in rural China. Future studies should be undertaken on diabetes prevention strategies tailored specially for this population.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15007033; Results.

Implementation of a Psychosocial Intervention Program for Working Caregivers

The overall aim of this pilot study was to examine the feasibility and acceptability of a multicomponent, psychosocial intervention specifically designed to meet the unique needs of caregivers who are balancing caregiving duties with work responsibilities. Seventy-one family caregivers employed at a private, nonprofit institution in South Florida were randomized to either the Caregiver Workstation condition (n = 35) or a control condition (n = 36). Sixty-two caregivers completed the 5-month follow-up. Our results indicate that an intervention tailored to the time demands of a working caregiver is feasible, acceptable to caregivers, and has the potential to have positive long-term effects. Currently, there are limited data available regarding the benefits of employer programs for caregivers or the type of programs caregivers find most useful. This pilot study is the first step in developing a working caregiver intervention program that can be implemented on a broad-scale basis.

Comparing the Effect of a Moderate Physical Activity Intervention on the Mental Health Outcomes of African American and Caucasian Dementia Family Caregivers: A Secondary Data Analysis

Increased attention to the effects of the stressful demands of caregiving on the mental health of dementia caregivers has resulted in the development of numerous interventions. The current study is a secondary analysis of a randomized controlled trial that tested a 12-month moderate physical activity intervention with dementia caregivers. Our secondary data analysis examined racial differences in caregiver mental health outcomes including subjective burden, depressive symptoms, and positive affect, as well as differences in physical activity. A total of 211 community-dwelling dementia family caregivers were randomly assigned to a 12-month Enhanced Physical Activity (treatment) Intervention (EPAI) or a Caregiver Skill Building (control) Intervention (CSBI). Of these, 34 African American and 80 Caucasian caregivers completed the study. At baseline, race was associated with subjective burden and positive affect, but not with depressive symptoms. Post intervention (12 months), there were no racial differences in subjective burden or depressive symptoms. However, race was significantly associated with decreased positive affect (p = 0.003) and decreased total minutes of physical activity (p = 0.012). Findings suggest that the mental health needs of African American caregivers warrant additional exploration, where physical activity may be of benefit. These findings provide a cultural perspective to consider during intervention development for future nurse-driven research.

Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families

PURPOSE

Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown.

DESIGN

Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families.

FINDINGS

We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others.

DISCUSSION AND CONCLUSIONS

Collective caregiving of MA elders warrants further investigation.

IMPLICATIONS FOR PRACTICE

Exploration of collective caregiving may provide a foundation for tailored family interventions.

Paid Home Care in the 21st Century: Need and Demand

Diverging trends will affect the use of home-delivered, paid, disability-related services over the next 30 years. Age-adjusted rates of disability appear to be declining, but the sheer numbers of elders in future cohorts imply that use of all types of long-term support services (LTSS) will increase markedly. Trends in ability to pay, home ownership, and long-term care insurance coverage will combine with consumer preferences for care at home thereby shifting an increasing proportion of LTSS to home settings. Most important for home-delivered care is the unflagging commitment of spouses and other family members to provide informal support complementary to home-delivered, paid services, which continues despite demographic and labor market challenges. Working against these trends in resources for LTSS at home are the increasing cost of services and the reluctance of government to pay adequately for LTSS, whether for lower income elders or as universal coverage for needed supportive services at home.

A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China

OBJECTIVES

This study was designed to examine the effect of health literacy on diabetes prevention and control and risk factors for low diabetes health literacy among elderly individuals with prediabetes in rural areas in China.

DESIGN SETTING AND PARTICIPATES

A cross-sectional survey was conducted among elderly individuals in rural communities in Yiyang City in China. Multi-staged cluster random sampling was used to select 42 areas and 434 individuals with prediabetes who were interviewed using a questionnaire on diabetes health literacy in China.

MAIN OUTCOME MEASURES

Participants were asked for general information (age, gender, marital status, history of hyperglycaemia, family history of diabetes mellitus, presence of other diseases and level of education). Binary logistic regression analysis was used to identify risk factors for poor health literacy concerning diabetes prevention and control among elderly subjects with prediabetes.

RESULTS

The median health literacy score for diabetes prevention and prediabetes control was 10.0 (IQR 7.0-13.0). The level of diabetes health literacy among men was lower than among women (OR 2.831, 95% CI 1.818 to 4.408), and lower among respondents with 1-6 years of education than among those with 6 years or more of education (OR 14.274, 95% CI 5.927 to 34.375). Those with less than 1 year of education had the lowest literacy (OR 31.148, 95% CI 11.661 to 83.204). The level of diabetes health literacy among elderly individuals with prediabetes but no history of hyperglycaemia was lower than among those with a history of hyperglycaemia (OR 2.676, 95% CI 1.101 to 6.504).

CONCLUSIONS

Health literacy concerning diabetes prevention and control among elderly individuals with prediabetes was very low in rural China. Appropriate health education for elderly individuals with low educational levels should be incorporated into diabetes prevention efforts.

TRIAL REGISTRATION NUMBER

ChiCTR-IOR-15007033; Results.

Caregiver burden and vocational participation among parents of adolescents with CF

AIM

Cystic fibrosis (CF) require parents to make significant lifestyle changes to accommodate their children's treatments. We examined the impact of CF-related caregiving on parents' occupational adjustment and labor supply in terms of organizational changes, presenteeism, and absenteeism.

METHODS

Nineteen Italian CF referral centers joined the LINFA group. We enrolled 168 adolescents with the disease and their parents (n = 225) in a cross-sectional survey research. Patients and their parents answered a self-administered questionnaire (child: SF-12, satisfaction with life, MRC Dyspnea scale; parent: caregiver burden scale, short depression-happiness scale, self-rated health, socio-demographic factors). A pediatrician recorded clinical information (pulmonary exacerbations, CF-related complications, treatment, BMI percentile, Fev1 %).

RESULTS

Patients mean age was 16 ± 2.6 and mean BMI percentile was 42.1 ± 29.1; 92 patients (55%) had FEV1 % > 80. Mean parents' age was 45.9 ± 5.9 years, and 59% were women; 75% of women and 24% of men reported to be the primary caregiver. Only 12% had a graduate or post-graduate degree and 56.4% were employed. Approximately 34% of parents reported short depression-happiness scale scores suggestive of clinical depression. Higher caregiving strain was associated with increased likelihood of changing job, work shift schedule, or giving up career opportunities in order to fulfill their caregiving role and increased productivity losses due to family leaves and presenteeism.

CONCLUSION

Caregiving burden is a relevant and frequent issue among parents of adolescent patients with cystic fibrosis. We showed that the humanistic and vocational impact of caring for young patients with the disease is striking and demands health-care and welfare supportive actions.

Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia

OBJECTIVES

Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver; they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility.

METHODS

This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis.

RESULTS

The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor; negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility.

CONCLUSION

The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.

The Concept of Missing Incidents in Persons with Dementia

Behavioral symptoms of dementia often present the greatest challenge for informal caregivers. One behavior, that is a constant concern for caregivers, is the person with dementia leaving a designated area such that their whereabouts become unknown to the caregiver or a missing incident. Based on an extensive literature review and published findings of their own research, members of the International Consortium on Wandering and Missing Incidents constructed a preliminary missing incidents model. Examining the evidence base, specific factors within each category of the model were further described, reviewed and modified until consensus was reached regarding the final model. The model begins to explain in particular the variety of antecedents that are related to missing incidents. The model presented in this paper is designed to be heuristic and may be used to stimulate discussion and the development of effective preventative and response strategies for missing incidents among persons with dementia.

Development and psychometric properties of the family distress in advanced dementia scale

OBJECTIVE

The majority of scales to measure family member distress in dementia are designed for community settings and do not capture the unique burdens of the nursing home (NH) environment. We report the psychometric properties of a new Family Distress in Advanced Dementia Scale for use in the NH setting.

DESIGN, SETTING, PARTICIPANTS

Cross-sectional questionnaire of 130 family member health care proxies of NH residents with advanced dementia in 31 Boston-area NHs.

METHODS

Thirty-one initial items were evaluated, measuring the frequency over the past 3 months of sources of distress. Exploratory factor analysis identified domains of distress; Cronbach's alpha was computed for each domain. Associations between the domains and other measures were evaluated using Pearson correlation coefficients, including measures of depression (PHQ-9), satisfaction with care (Satisfaction with Care at the End-of-Life in Dementia [SWC-EOLD]), and caregiver burden (Zarit Burden Interview short version).

RESULTS

Factor analysis suggested 3 domains: emotional distress (9 items), dementia preparedness (5 items), and NH relations (7 items). Cronbach's alpha coefficients were 0.82, 0.75, and 0.83 respectively. The PHQ-9 correlated most strongly with the emotional distress factor (r = 0.34), the SWC-EOWD correlated most strongly with the NH relations factor (r = 0.35), as did the Zarit Burden Scale (r = 0.50).

CONCLUSIONS

The Family Distress in Advanced Dementia Scale encompasses 3 domains of distress. This scale represents a much needed tool to assess distress among family members of NH residents with advanced dementia and provides a metric to evaluate interventions in the population.

How family carers engage with technical health procedures in the home: a grounded theory study

OBJECTIVES

To explore the experiences of family carers who manage technical health procedures at home and describe their learning process.

DESIGN

A qualitative study using grounded theory.

PARTICIPANTS

New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed.

METHODS

Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined.

RESULTS

The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a 'technical' solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs.

CONCLUSIONS

The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers' emotional and behavioural responses to health technology during the training process.

Impact of JIA on parents' work absences

OBJECTIVE

Children with JIA have long-term morbidity and require extensive parental assistance. This study aimed to evaluate the impact of having a child with JIA on parents' missed work time, which can lead to decreased work productivity.

METHODS

The Truven Health MarketScan Commercial Database (2000-9) was accessed to identify a cohort of parents having a child with newly diagnosed JIA. For comparison, a cohort of parents having no children with JIA was identified and matched with the preceding cohort. Parents' work absences were analysed using descriptive statistics and multivariable regression. Estimates were weighted to be generalizable to the US employer-sponsored insurance population.

RESULTS

The study identified 108 parents having a child with newly diagnosed JIA (mean age 42.5 years), representing an estimated 3335 (weighted) parents nationally. Most of them were from the South (45%), male (71%) and employed in the transportation and utilities industry (58%). The demographic characteristics of the control cohort of parents were generally similar. Children with JIA (mean age 10.6 years) represented an estimated 3528 cases nationally. The mean number of reported missed work-time hours was 281.81 (s.e. 40.50) in a 9 year period for parents having a child with JIA compared with other parents 183.36 (28.55). Work-time loss was significantly related to having a child with JIA, sex and geographical region of residence. Parents having a child with JIA were 2.78 times more likely to report work-time loss [odds ratio (OR) 2.78 (95% CI 1.47, 5.26)] than those having no children with JIA.

CONCLUSION

Parents having a child with JIA report significant work-time loss compared with parents with no children having JIA, particularly during the year following the child's diagnosis.

Impact of Providing Care on the Risk of Leaving Employment in Canada

Le vieillissement de la population entraînera sans doute une augmentation du nombre de personnes ayant besoin d’aide. Il est bien connu qu’une grande part de l’aide reçue provient, et continuera de provenir, du réseau informel de proches et d’amis. Cependant, les effets qu’exerce la prestation de soins sur les trajectoires d’emploi des individus lorsque ces soins sont cumulés à des régimes d’emploi d’intensités variées ou à des responsabilités parentales ont été peu analysés. La présente étude utilise les données de l’Enquête sociale générale, cycles 20 et 21, pour évaluer l’impact de fournir des soins à un conjoint, un parent ou beau-parent, une autre personne apparentée ou une personne non-apparentée sur le risque de quitter son emploi à l’aide des modèles à risques proportionnels. Les analyses montrent que le fait de prodiguer des soins à un parent ou beau-parent augmente la probabilité de quitter son emploi, mais seulement chez les femmes qui travaillent à plein temps, ainsi que chez les hommes et les femmes qui n’ont pas d’enfants ou qui ont seulement des enfants d’âge adulte.

Universality of aging: family caregivers for elderly cancer patients

The world population is aging, with the proportion of older people (65+ years) expected to reach 21% in 2050 and to exceed the number of younger people (aged 15 or less) for the first time in history. Because cancer is particularly a chronic disease of older people, a large increase in the number of elderly patients with cancer is anticipated. The estimated number of new cancer cases worldwide among people over 65 is expected to grow from about 6 million in 2008 to more than 11 million during the coming decade. By 2030, individuals over 65 are expected to account for 70% of all cancer patients in the Western world. Along with the increase in oncology patients, the number of older people caring for their ill spouses or other relatives is also growing, with the ensuing toll on these caregivers causing major concern, especially in western countries. In different societies the characteristics of family caregiver stressors, cultural norms concerning caregiving, and the availability of support have a huge impact on those providing care. Any study of older caregivers of older cancer patients requires an integrative evaluation of aging that takes into account cultural, social, psychological, and behavioral variables. This review proposes a critical discussion of the multidimensionality of the caregiving and of the impact that age, culture, and gender have on it.

Full-time employed and a family caregiver: a profile of women's workload, effort, and health

BACKGROUND

Women provide care for elderly family members while managing their other responsibilities, including full-time employment.

METHODS

This descriptive study used an inductively derived workload-effort-health theoretical model to examine workload, effort, and health among 46 full-time employed family caregivers [CG] of community-dwelling older adults from a larger, nonprobability, cross-sectional sample of 110 CGs.

FINDINGS

The women's caregiving workload (time, difficulty, care recipient's [CR] function), effort (perceived exertion of energy experienced in doing a workload), self-assessed health [SAH], depressive symptoms, and sources of help were richly described, and several associations were found, including higher physical and mental effort, were significantly correlated with higher workload time and difficulty and lower CR function, but not SAH. Higher mental effort and workload, and poorer SAH were significantly correlated with high depressive symptoms. Worse effort, workload, and health experiences were reported by daughters and by women who lived with their CR; those who did not have family or formal caregiving help had higher mental effort and were more depressed, suggesting an area for further study.

CONCLUSIONS

Suggestions are offered for richer measurement of employment status, caregiving workload, and effort. Findings provide a unique profile of full-time employed women CGs' workload, effort (that is, how they do the work), and health, toward a stronger understanding of how women manage multiple workloads. Workplace policies are needed to address workload, effort and health in this informal caregiving workforce.

Factors affecting employment among informal caregivers assisting people with multiple sclerosis

The objective of this study was to identify characteristics of informal caregivers, caregiving, and the people with multiple sclerosis (MS) receiving assistance that are associated with reduced caregiver employment. Data were collected during telephone interviews with 530 MS caregivers, including 215 employed caregivers, with these survey data analyzed using logistic regression. Poorer cognitive ability by the care recipient to make decisions about daily tasks and more caregiving hours per week predicted reduced caregiver employment. Better physical health domains of caregiver quality of life were associated with significantly lower odds of reduced employment. Health professionals treating informal caregivers, as well as those treating people with MS, need to be aware of respite, support, and intervention programs available to MS caregivers and refer them to these programs, which could reduce the negative impact of caregiving on employment.

Alzheimer's in the workplace: a challenge for social work

It is estimated that 5.3 million Americans have Alzheimer's disease or a related disorder (ADRD) with approximately 500,000 of these persons younger than 65. Moreover, the number of people affected by the disease will increase 350% by the middle of this century. Although research exists on organizational policies with regard to caregivers, very little is known about how organizations deal with employees themselves who show symptoms of ADRD. This article reports on a pilot study of employers' responses to dementia as it impacts both caregiving employees and employees who themselves show signs of cognitive impairment.

Activities of daily living in Mexican American caregivers: the key to continuing informal care

La familia drives elder care in Mexican-American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated "no help needed" on the Katz ADL, whereas all but one reported "help needed" during semistructured interviews with cultural brokers. In addition to the discrepancy between results on the Katz ADL and interviews, findings include consideration of nursing home placement by moderately acculturated caregivers and minimization of their illnesses by caregivers. Additional methods of MA caregiver assessment may be needed due to the questionable accuracy of the Katz ADL; additional research should explore minimization and acculturation in MA caregivers.

Work restrictions experienced by midlife family care-givers of older people: evidence from six European countries

This paper examines differences in work restrictions of midlife family carers of older people in terms of prevalence, gender and explanatory variables, in six European countries: Germany, Greece, Italy, Poland, Sweden and the United Kingdom. A sample of 2,897 carers aged 45–64 was extracted from the EUROFAMCARE (Services for Supporting Family Carers of Older People in Europe: Characteristics, Coverage and Usage) European project database, in order to analyse four possible work restrictions experienced in connection with the activity of care-giving: the reduction of working hours; giving up working; difficulties in career developments and forced occasional work. The results show that work restrictions are experienced differently between countries especially by women: they are reported to a higher degree in the United Kingdom, Germany and Greece, less so in Italy, and seldom in Poland and Sweden. Gender differences within countries are not so marked. Country differences are explained in the light of the different welfare regimes characterising the countries under investigation, in order to elucidate how policy makers may act to improve working carers' conditions through appropriate policies.

Paid caregiver motivation, work conditions, and falls among senior clients

The purpose of this study was to determine the motivation of paid non-familial caregivers of seniors, understand more about their work conditions, and identify any links to negative outcomes among their senior clients. Ninety-eight paid caregivers (eighty-five female and thirteen male), recruited from multiple sites (i.e. senior centers, shopping malls, local parks, lobbies of senior apartments, caregiver agency meetings) completed face-to-face questionnaires and semi-structured interviews. We found that 60.7% of participants chose to become a caregiver because they enjoyed being with seniors while 31.7% were unable to obtain other work, and 8.2% stated it was a prerequisite to a different health related occupation. Caregivers stated that the most challenging conditions of their work were physical lifting (24.5%), behavioral and psychological symptoms of dementia (24.5%), senior depression/mood changes (18.4%), attachment with impending death (8.2%), missing injuries to client (5.1%), lack of sleep (4.1%), and lack of connection with outside world (3.1%). Caregivers who reported that the best part of their job was the salary, flexible hours, and ease of work were significantly more likely to have clients who fell and fractured a bone than those who enjoyed being with seniors (job characteristics, 62.5% vs. senior enjoyment, 25.6%; p<0.004). We concluded that in pursuing their occupation, paid caregivers are motivated commonly by their love of seniors and also by their lack of other job opportunities. Paid caregivers frequently face challenging work conditions. When seeking a caregiver for a senior, motivation of the caregiver should be considered when hiring.

Treatment guidelines for Alzheimer's disease: redefining perceptions in primary care

BACKGROUND

Current treatment guidelines for Alzheimer's disease (AD) do not reflect more recently collected data on therapeutic outcomes other than cognitive function and memory, and this has led to a limited understanding of the value of drug therapy in AD.

OBJECTIVES

To evaluate the need to revise treatment guidelines for AD, to review data that have become available since the publication of current guidelines, and to communicate how existing guidelines and relevant new data can be valuable to the primary care provider who assesses and treats patients with AD.

DATA SOURCES

A MEDLINE search was conducted to identify existing treatment guidelines using the MeSH headings Alzheimer disease-drug therapy AND practice guidelines. The alternative terms treatment guidelines, practice parameter, and practice recommendation were also searched in conjunction with the MeSH term Alzheimer disease-drug therapy. Additionally, MEDLINE was searched using the term dementia and publication type "practice guideline." All searches were limited to articles published within the last 10 years, in English. A total of 116 articles were identified by these searches. Additional publications were identified by manually searching the reference lists of these articles and of published clinical trials of AD therapies.

STUDY SELECTION AND DATA EXTRACTION

Current AD treatment guidelines and clinical trial results for AD treatment options were extracted, reviewed, and summarized to meet the objectives of this article.

DATA SYNTHESIS

Current guidelines support the use of cholinesterase inhibitors in patients with mild to moderate AD. More recent clinical research indicates that cholinesterase inhibitor treatment provides effectiveness across a wide range of dementia severity and multiple symptom domains. These medications also significantly decrease caregiver burden and may lower the risk for nursing home placement.

CONCLUSIONS

The expanding literature on AD medications suggests that treatment guidelines need to be reexamined. Recent data emphasize preservation of abilities and delay of adverse outcomes in AD patients rather than short-term improvements in cognitive test scores. Treatment appears to provide the greatest benefit when it is initiated early in the course of the disease and maintained over the long term. Revised treatment guidelines should address newer medications and more recent outcomes considerations, as well as provide guidance on how long to continue and when to discontinue pharmacotherapy for AD.

Living with an aging parent: "It was a beautiful invitation"

In the United States and globally, increasing numbers of older parents are living with their adult children. Making the decision to live together requires careful thought and planning; particularly when the decision means the children will be responsible for their elder parents' care, the physicians of all parties should be consulted. More than one-third of caregivers state that they seek advice from their physician or other clinician when information is needed about this transition. Using the case of a couple receiving care from their daughter in her own home, we review the prevalence and epidemiology of adult children caring for a parent in the adult child's home, important issues to consider, and a framework for clinicians to help guide their patients through this transition. We describe the physician's ongoing role in caring for and advising both the older parent and the adult children during common stages of multigenerational living: before the move and during coresidency and subsequent care transitions.

Integrating behavioral psychology services into adult day programming for individuals with dementia

Many individuals with dementia and problem behavior are served in nursing home settings long before health issues necessitate constant medical care. Alternative community-based adult day health care programs allow individuals with dementia to remain in their home with their families at a substantially reduced cost; however, many adult day programs face the same difficulties in managing problem behavior as family members do, leading to premature termination of services. This article describes a multiyear project that integrated behavior analytic services into an adult day program for individuals with dementia and problematic behavior. A comprehensive practicum system was developed to provide assessment and treatment services that allowed consumers with problem behavior to remain successfully served in adult day programming while postponing out-of-home nursing home care.

Reactions to caregiving in frailty research

Frailty is a syndrome characterized by decreased functional ability and associated with institutionalization. Many community-living frail older people rely upon the support of a family member or friend. However, there is a paucity of research exploring the reactions to caring for older people empirically identified as frail. The objective of this study was to describe carers of community-living older people identified as frail, using accepted criteria, identify care characteristics and ascertain relationships that contribute to reactions to caregiving. A cross-section of carers of community-living frail people (≥ 70 years) completed a postal questionnaire; the Caregiver Reaction Assessment (CRA) evaluated reactions to caregiving. Ninety-three carers completed the questionnaire (68% response rate). Correlation and multivariate analysis of variance tests (MANOVA) demonstrated statistically significant relationships between several care characteristics and reactions to caregiving. Carers who provide more than 20 h of care per week and report a low self-perceived health status are susceptible to significant health and financial problems and disruption to their daily schedule. Two strategies for improving reactions to caring for persons with frailty are proposed: financial support that assists carers to improve their health status and the provision of regular formal assistance, rather than intermittent respite care.

2010 Alzheimer's disease facts and figures

Alzheimer's disease (AD) is the seventh leading cause of all deaths in the United States and is virtually tied with the sixth leading cause of death-diabetes. AD is the fifth leading cause of death in Americans aged 65 and older. Although other major causes of death have been on the decrease, deaths because of AD have been rising dramatically. Between 2000 and 2006, heart disease deaths decreased 11.1%, stroke deaths decreased 18.2%, and prostate cancer-related deaths decreased 8.7%, whereas deaths because of AD increased 46.1%. Older African-Americans and Hispanics are more likely than older white Americans to have AD or other dementia. Current estimates are that African-Americans are about 2 times more likely, and Hispanics about 1.5 times more likely, than their white counterparts to have these conditions. However, the relationship of race and ethnicity to the development of AD and other dementias is complex and not fully understood. In 2009, nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to persons with AD and other dementias; this care is valued at nearly $144 billion. Medicare payments for services to beneficiaries aged 65 years and older with AD and other dementias are three times higher than for beneficiaries without these conditions. Total payments for 2010 for health care and long-term care services for people aged 65 and older with AD and other dementias are expected to be $172 billion (not including the contributions of unpaid caregivers). An estimated 5.3 million Americans have AD; approximately 200,000 persons under age 65 with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050 the time of every 70 seconds is expected to decrease to every 33 seconds. Over the coming decades, the baby boom population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11-16 million people. Dramatic increases in the numbers of "oldest old" (aged 85 years and older) across all racial and ethnic groups will also significantly affect the numbers of people living with AD. This report provides information to increase understanding of the public health effect of AD, including incidence and prevalence, mortality, costs of care, and effect on caregivers and society in general. This report also sets the stage for better understanding the relationship between race and ethnicity and the development of AD and other dementias.

Predictors of mental health, subjective burden, and rewards in family caregivers of patients with chronic liver disease

Patients with chronic liver disease (CLD) often experience severe symptoms that cause functional impairment and necessitate assistance from a family caregiver. Few studies investigate family caregivers of patients with CLD. This descriptive correlation study described demographic characteristics, depressive and anxiety symptom levels, and prevalence of hazardous drinking, rewards, and subjective burden and explicated predictors of subjective burden and mental health status for a convenience sample of 73 family caregivers of persons with CLD. Interventions are needed to offset decreased income reported by caregivers and to treat depressive symptoms; clinically significant levels were present, and clinical referrals were warranted in this study sample.