Depressive symptoms in family caregivers of long-stay patients

Prevalence and determinants of stress of informal caregiving: A cross-sectional study among informal caregivers of hospitalised patients in a tertiary hospital in Nigeria

Background

Caring for patients in the hospital can cause a lot of stress for the caregivers, especially those who are involved with informal caregiving such as family members. Little is known in Nigeria on the stress of informal caregiving in the hospital environment. This study assessed the informal caregivers' stress level and their determinants in a tertiary hospital in Ilorin, Nigeria.

Methodology

This was a hospital-based cross-sectional study. Between September and October 2019, using a simple random sampling method, data were collected from 400 informal caregivers of patients in University of Ilorin Teaching Hospital with interviewer-administered questionnaire which included socio-demographic characteristics, Caregivers Strain index (CSI) and caregivers' stress from institution and other factors index (CSIOI). Analysis was performed, and prevalence and determinants of stress of informal caregiving were presented using descriptive statistics and logistic regressions. P < 0.05 was considered statistically significant.

Results

The majority, 381 (95.2%) of the informal caregivers, reported great stress levels using CSI, while 227 (56.7%) experienced a great level of stress with the CSIOI. Predictors of caregiver stress were perception that staying around was stressful (odds ratio [OR] - 17.5, P < 0.001), felt their patients will not be well cared for if not around (OR - 6.1, P < 0.001), staying at the hospital for >30 days (OR - 2.6, P = 0.001).

Conclusion

The informal caregivers experienced a great level of stress taking care of their patients on admission in the hospital. It is, therefore, expedient that issues surrounding the comfort of the informal caregivers as they care for their patients should be included in hospital policies.

Clinical characteristics of participants enrolled in an early identification and healthcare management program for dementia based on cluster analysis and the effectiveness of associated support efforts

OBJECTIVE

Although early identification and management services for dementia have become more widespread, their efficacy and the clinical characteristics of service have yet to be fully evaluated. Therefore, the objective of this study is to clarify these issues.

MEASUREMENTS

The subjects were 164 Japanese users of an early identification and management program for dementia, known as the Initial-phase Intensive Support Team (IPIST), between 2013 and 2015. Nonhierarchical cluster analysis was used to derive subgroups based on cognitive status and ability in activities of daily living (ADL) and behavioral and psychological symptoms of dementia (BPSD). One-way analysis of variance was performed to evaluate differences among the groups derived by the cluster analysis. A paired t test was used to assess how the clinical status of the groups changed between baseline and follow-up.

RESULTS

Four groups were identified by cluster analysis, i.e. a mild group, a moderate group, a BPSD group with moderate cognitive impairment and severe BPSD, and a severe group with severe cognitive impairment and severe BPSD. Although there were no significant improvements in cognitive impairment or ADL in any group, significant improvements were found in BPSD in the BPSD and severe BPSD groups. Caregiver burden was significantly lessened in all groups. Clinical diagnosis and long-term care insurance service utilization rates were significantly improved overall.

CONCLUSION

The users of IPIST were classified into four subgroups based on their clinical characteristics. The IPIST program could improve the quality of life of people with dementia and their caregivers.

Perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders: a qualitative study

Background

Family caregivers of individuals with chronic psychiatric disorders play an important role in the management of the patient's conditions, which interferes with other activities of daily living, work, social and leisure activities.

Objective

This study was conducted in an Iranian context to explore the perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders.

Methods

The current qualitative study was conducted on the basis of conventional content analysis. Participants were 15 family caregivers of individuals with chronic psychiatric disorders who were selected by Purposeful sampling method between July 2016 and March 2017 in Tehran, Iran. The data was collected via in-depth semi-structured interviews. The interviews were tape recorded, written and transcribed. Then, data were analyzed by inductive content analysis method.

Results

Data analysis led to extraction of 3 main categories and 10 sub categories. Obstacles to leisure-time of family caregivers have been placed in three main categories which are patient-related factors (Resentment from psychological problems, Resentment from behavioral problems, Need for continuous monitoring and access), caregiver-related factors (Physical harm, Psychosocial harm, Temporal stress, Accumulation of responsibilities, Concerns), and community-related factors (Feeling of sympathy and rejection, Social stigma).

Conclusion

Understanding the barriers of leisure in this group of family caregivers has contributed to understanding the family caregivers' perception in this area and regarding their leisure, it can provide a broader perspective to mental health therapists, rehabilitation managers and policy makers for understanding the needs, addressing the challenges and barriers of this group of family caregivers.

Caregiver Involvement in the Use of Assistive Devices by Frail Older Persons

The population of persons over age 65 years is increasing, and with this trend there is an increase in number of older persons with disabilities, or frail elders. The importance of supportive environments for home-based frail elders has been recognized. Supportive environments include the presence of family caregivers and appropriate assistive devices. Assistive devices (AD) offer the potential to decrease frail elder's need for personal assistance, and could reduce some of the burden expressed by caregivers. The inclusion of family caregivers in treatment planning and its implementation is a component of occupational therapy practice. Occupational therapists are also recognized as the lead professional in the provision of most assistive devices. However, there has been little research on the involvement of family caregivers in the use of assistive devices. The purpose of this study was to examine the relationship between caregiver involvement and the use of, and satisfaction with, assistive devices by frail elders. Interviews regarding assistive devices were conducted with 20 frail, cognitively intact elders who had a primary caregiver in their homes. Results indicate that elders regard assistive devices as very useful in saving time, conserving energy, reducing frustration, and providing a feeling of security. Caregivers were involved in the use of assistive devices when the device was first acquired (early caregiver involvement) and made suggestions for using the devices. They also encouraged, instructed, and assisted with the use of devices later, as necessary. There was a relationship between early caregiver involvement and involvement at the time of the interview (later caregiver involvement). Verbal encouragement and caregiver's use of assistive devices to help perform tasks were strongly associated with both device use and satisfaction. The results reinforce the importance of caregiver involvement with assistive devices used by frail older persons.

Effects of Hardiness and Appraisal on the Psychological Distress and Physical Health of Caregivers to Elderly Relatives

The goal of this study was to identify characteristics of caregivers that contribute to differences in psychological distress and physical health in family caregivers to elderly relatives. It was hypothesized that hardiness would predict caregiver's distress and physical health beyond what could be accounted for by the demands of caregiving (relative's cognitive impairment and functional/behavioral impairment, and caregiver's level of responsibility for needed care); that hardiness would decrease distress and increase physical health; and that the effect of hardiness would be mediated by appraisals of caregiving. In a sample of 53 caregivers to relatives age 65 or older, results indicated that both hardiness and appraisals predicted psychological distress (depression and life satisfaction). Neither predicted physical health. Appraisals partially explained the relationship between hardiness and psychological distress, but it appears that both general personality characteristics and situation-specific perceptions determine the impact on the caregiver.

Needs and Supports for Family Caregivers of Chronically Ill Elders

Family members provide extensive care to elders in the home. Such care requires a level of knowledge and skill unprecedented by lay people. Yet, the needs of family caregivers often are ignored and the health risks undetected. The purpose of this article is to assist home care nurses in identifying caregivers at risk, assessing family care-giver needs, and intervening to provide necessary resources. Needs are classified according to caregiver role needs and caregiver health maintenance and/or health promotion needs. Resources are identified that home care nurses can use in developing interventions to assist and support family caregivers.

Caregiving networks-using a network approach to identify missed opportunities

OBJECTIVES

This study demonstrates the added value to caregiving research by using a multi-informant social network approach within the context of Alzheimer's disease and related dementia.

METHOD

Sixty-six informants from 24 families enumerated caregiving network members in 2012. Comparisons were made between networks based on a single informant versus multiple informants in terms of network composition and caregiving roles, core-periphery structure, and identification of "missed opportunities" in recruitment.

RESULTS

On average, each informant beyond the index enumerated 6.2 new members, resulting in about 10 new members per family network when the multiple-informant approach is used. Compared with index informants' networks, multi-informant networks showed an 85% increase in identification of direct care providers (1.71 compared with 3.42) and a 48% increase in identification of those involved in care decision making (3.33 compared with 4.92). Informants from the same network generally showed agreement in reported participation in caregiving activities. However, the reports of non-participation in these roles were less consistent among the informants. Resulting structure indicated a core caregiving network (M = 6.12 members), with semi-peripheral and peripheral members (M = 5.19 and M = 14.83 members, respectively).

DISCUSSION

Results suggest that an iterative, targeted sampling approach with at least three informants allows for a more comprehensive assessment of caregiving processes. Applying this approach in future research will greatly enhance our knowledge and better inform future interventions to facilitate family adaptation.

Confirmatory factor analysis of the depressive cognition scale

The purpose of this study was to validate the single-factor structure of the Depressive Cognition Scale (DCS) among individuals from the U.S. general population. The sample was composed of 629 adults from 42 states of the United States. All measures of model fit of the DCS exceeded the recommended criteria for the good model fit (χ(2)/df = 2.57, goodness-of-fitness index = .98, adjusted goodness-of-fitness index = .96, comparative fit index = .99, Tucker Lewis index = .98, root mean square error of approximation = .05, root mean residual = .01, and the P value for test of close fit = .464). Thus, the DCS was found to be a reliable and valid instrument to measure depressive cognitions among individuals from the general population.

Spousal Caregiving in the Institutional Setting: Task Performance

Cette étude examine le phénomène des soins donnés par l'épouse à la suite du placement en établissement de son conjoint âgé. En théorie, l'étude puise dans la perspective d'interprétation sociologique et dans le concept de carriére. Son aspect méthodologique repose sur un cadre longitudinal et prospectif et réunit les approches quantitatives et qualitatives. Les données sont tirées d'une etude plus vaste qui explorait la transition vers un état de quasi-veuvage. L'article traite d'un aspect des soins suivant l'admission de l'époux en centre de soins à long terme, soit de l'accomplissement des tâches. Aux termes de l'etude, les épouses effectuent un nombre substantiel et varié de tâches reliées aux soins personnels, instrumentaux, relationnels et récréatifs. Elles considêrent les visites comme la plus importante de leur tâche mais accordent également une valeur importante à la présence, á l'amour et à l'appui, aux petites choses qu'elles font pour leur mari et à la surveillance de leur santé et de leur bien-être. Généralement, elles exécutent des tâches qu'elles jugent du ressort de leurs responsabilités. La réalisation des tâches se place dans un contexte servant à expliquer, en partie, leur engagement continu dans la fourniture des soins apràs l'admission de leur époux en établissement de soins de longue durée. La portée de cette étude souligne le besoin de collaboration entre les épouses soignantes et le personnel dans une perspective de maintien et d'augmentation de la qualityé des soins accorded par les épouses aînées dont le conjoint est placé en établissement.

Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan

AIMS

To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan.

BACKGROUND

Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese.

DESIGN

A cross-sectional descriptive correlational design was used to conduct this study.

METHODS

A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests.

RESULTS

Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (β = -0.16, p < 0.01 and β = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively.

CONCLUSIONS

Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.

Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer's disease

AIMS AND OBJECTIVES

This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease.

BACKGROUND

Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease.

DESIGN

Cross-sectional, descriptive correlation design.

METHODS

Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests.

RESULTS

Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms.

CONCLUSIONS

Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.

Single session educational programme for caregivers of psychogeriatric in-patients--results from a randomised controlled pilot study

BACKGROUND

Family caregivers of patients with psychiatric or medical disorders are at risk of developing psychological distress. Studies including family caregivers of patients with dementia have shown that psychoeducative programmes reduce distress and postpone institutionalisation. Little is known about the effect of psychoeducation of relatives of psychogeriatric patients. The aim of this study was to investigate the effect of a single-session educational intervention of relatives of psychogeriatric in-patients.

METHODS

A randomised controlled intervention study was carried out with 16 relatives in the intervention group and 14 in the control group. The intervention was carried out as a single session programme. Primary outcome measures were psychological well-being and depression as measured by means of General Health Questionnaire (GHQ-30), Impact of Event Scale (IES) and Geriatric Depression Scale (GDS). Outcome measures were performed at baseline, at discharge and at 3-month follow-up.

RESULTS

Psychological distress was high. Daughters were more depressed and distressed than spouses. Patients' diagnoses did not seem to exert influence on the relatives' well-being. There was a significant worsening of psychological distress in the intervention group as measured by GHQ-30.

CONCLUSIONS

The study is small and results must be interpreted with caution. Distress among relatives was high regardless of patient's diagnosis. The results of the intervention might lead us to conclude that single-session interventions towards this specific group of relatives do not improve psychological stress and might, in some aspects, even worsen it.

Caring for patients with dementia: how good is the quality of care? Results from three health systems

OBJECTIVES

To describe the quality of dementia care within one U.S. metropolitan area and to investigate associations between variations in quality and patient, caregiver, and health system characteristics.

DESIGN

Observational, cross-sectional.

SETTING AND PARTICIPANTS

Three hundred eighty-seven patient-caregiver pairs from three healthcare organizations

MEASUREMENTS

Using caregiver surveys and medical record abstraction to assess 18 dementia care processes drawn from existing guidelines, the proportion adherent to each care process was calculated, as well as mean percentages of adherence aggregated within four care dimensions: assessment (6 processes), treatment (6 processes), education and support (3 processes), and safety (3 processes). For each dimension, associations between adherence and patient, caregiver, and health system characteristics were investigated using multivariable models.

RESULTS

Adherence ranged from 9% to 79% for the 18 individual care processes; 11 processes had less than 40% adherence. Mean percentage adherence across the four care dimensions was 37% for assessment, 33% for treatment, 52% for education and support, and 21% for safety. Higher comorbidity was associated with greater adherence across all four dimensions, whereas greater caregiver knowledge (in particular, one item) was associated with higher care quality in three of four care dimensions. For selected dimensions, greater adherence was also associated with greater dementia severity and with more geriatrics or neurologist visits.

CONCLUSION

In general, dementia care quality has considerable room for improvement. Although greater comorbidity and dementia severity were associated with better quality, caregiver knowledge was the most consistent caregiver characteristic associated with better adherence. These findings offer opportunities for targeting low quality and suggest potential focused interventions.

Social support and adjustment to caring for elder family members: A multi-study analysis

This multi-study analysis systematically examines research findings on relationships between social support and caregiver adjustment to discover whether informal support helps family caregivers. Caring for older relatives is an ongoing stressful life course event and role. Informal social support is often used as a predictor of caregiver adjustment outcomes. It is widely believed to enhance adjustment. Yet the varied research results do not necessarily support this belief. A computer-generated literature search of social sciences and medical databases produced thirty-five caregiving articles, published in refereed journals, which meet study parameters. A coding form was developed to categorize social support and adjustment variables for cross-tabular analyses. The findings show most relationships (61%) between social support and caregiver adjustment are not positively significant. Of the minority of positively significant relationships, neither perceived (available) nor received support is more important and neither instrumental nor socioemotional support is more likely to aid adjustment. Researchers and health care professionals need to explore the negative impact of social support and attributes of caregiver-care recipient relationships.

The relationship of quality of life, depression, and caregiver burden in outpatients with congestive heart failure

Primary caregivers of patients with congestive heart failure withstand enormous burden, often sacrificing their own quality of life. The relationship between caregiver burden and depression and patient quality of life and depression in this setting is unknown. Fifty outpatients were prospectively administered the Minnesota Living with Heart Failure Questionnaire and Beck Depression Inventory II (BDI-II). Caregivers were administered the Zarit Caregiver Burden Interview and BDI-II. The mean quality of life score was 35, and 26% had a BDI-II score >10. The mean Zarit Caregiver Burden Interview score was 16. Minnesota Living with Heart Failure Questionnaire, BDI-II, and Zarit Caregiver Burden Interview scores were all associated with lower ejection fraction, need for hospitalization, increased number of medications, and comorbidities. Patient Minnesota Living with Heart Failure Questionnaire score correlated with patient BDI-II, caregiver BDI-II, and Zarit Caregiver Burden Interview scores. Caregiver burden score correlated with both caregiver BDI-II and patient BDI-II. Death or hospitalization at 6 months was associated with caregiver burden and depressive symptoms and with patient quality of life and depressive symptoms. Caregivers of patients with congestive heart failure experience high caregiver burden and prevalence of depressive symptoms, which are related to the patient disease burden.

Employment status, social ties, and caregivers' mental health

The purpose of this study of mid-life and older women was to assess the relation between informal care provision and depressive symptoms, taking into account concurrent demands on women's time (including multiple caregiving roles and employment outside the home) as well as participants' access to potentially supportive social ties. This cross-sectional study included women ages 46-71, free from major disease, who provided complete health and social information in the 1992 Nurses' Health Study follow-up survey (n = 61,383). In logistic regression models predicting depressive symptoms, we examined the interaction between employment outside the home and informal care provision for a disabled or ill spouse or parent. We also investigated level of social ties, measured with the Berkman-Syme Social Network Index, as a potential modifier of the association between informal care provision and depressive symptoms. In all analyses, higher weekly time commitment to informal care for a spouse or parent was associated with increased risk of depressive symptoms. This relationship persisted whether women were not employed outside the home, were employed full-time, or were employed part-time. Higher weekly time commitment to informal care provision was associated with increased risk of depressive symptoms whether women were socially integrated or socially isolated. However, both informal care provision and social ties were potent independent correlates of depressive symptoms. Therefore, women who reported high spousal care time commitment and few social ties experienced a dramatic elevation in depressive symptoms, compared to women with no spousal care responsibilities and many social ties (OR for depressive symptoms=11.8; 95% CI 4.8, 28.9). We observed the same pattern among socially isolated women who cared for their parent(s) many hours per week, but the association was not as strong (OR for depressive symptoms=6.5; 95% CI 3.4, 12.7). In this cross-sectional study, employment status did not seem to confer additional mental health risk or benefit to informal caregivers, while access to extensive social ties was associated with more favorable caregiver health outcomes.

Meta-analysis of psychosocial interventions for caregivers of people with dementia

OBJECTIVES

To review published reports of interventions for caregivers (CGs) of persons with dementia, excluding respite care, and provide recommendations to clinicians.

DESIGN

Meta-analytical review. Electronic databases and key articles were searched for controlled trials, preferably randomized, published in English from 1985 to 2001 inclusive. Thirty studies were located and scored according to set criteria, and the interventions' research quality and clinical significance were judged.

SETTING

Home or noninstitutional environment.

PARTICIPANTS

Informal CGs-persons providing unpaid care at home or in a noninstitutional setting.

MEASUREMENTS

The primary measures were psychological morbidity and burden. Other varied outcome measures such as CG coping skills and social support were combined with measures of psychological distress and burden to form a main outcome measure.

RESULTS

The quality of research increased over the 17 years. Results from 30 studies (34 interventions) indicated, at most-current follow-up, significant benefits in caregiver psychological distress (random effect size (ES) = 0.31; 95% confidence interval (CI) = 0.13-0.50), caregiver knowledge (ES = 0.51; CI = 0.05-0.98), any main caregiver outcome measure (ES = 0.32; CI = 0.15-0.48), and patient mood (ES = 0.68; CI = 0.30-1.06), but not caregiver burden (ES = 0.09; CI = -0.09-0.26). There was considerable variability in outcome, partly because of differences in methodology and intervention technique. Elements of successful interventions could be identified. Success was more likely if, in addition to CGs, patients were involved. Four of seven studies indicated delayed nursing home admission.

CONCLUSION

Some CG interventions can reduce CG psychological morbidity and help people with dementia stay at home longer. Programs that involve the patients and their families and are more intensive and modified to CGs' needs may be more successful. Future research should try to improve clinicians' abilities to prescribe interventions.

Reverberations of family illness: a longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study

OBJECTIVES

. This study examined the association between caregiving for disabled or ill family members, estimated to occur in more than 22 million US households, and change in mental health.

METHODS

We assessed 4-year change in mental health among 37 742 Nurses' Health Study participants with the Medical Outcomes Study Short-Form 36.

RESULTS

Women who provided 36 or more weekly hours of care to a disabled spouse were almost 6 times more likely than noncaregivers to experience depressive or anxious symptoms (multivariate odds ratio [OR] = 5.6; 95% confidence interval [CI] = 3.8, 8.3). Caring for a disabled or ill parent (>or= 36 weekly hours) was associated with a less dramatic elevation in depressive or anxious symptoms (multivariate OR = 2.0; 95% CI = 0.9, 4.3).

CONCLUSIONS

In this population, caregiving was associated with increased risk of depressive or anxious symptoms.

Relatives of stroke patients--their experiences and needs in hospital

This study explores the experiences and needs of relatives of hospitalized stroke patients. In semi-structured interviews, 17 relatives of stroke patients were asked about their experiences during the hospitalization period. The interviews were analysed by thematic content analysis. The findings indicate that the experiences of the relatives change during the hospitalization period, and that they are influenced by four factors: the individual character of the relatives, the position of the patient, the people in the relatives' social environment and the hospital situation. Four categories of needs were also found: the need for information, communication, support and accessibility.

The stress process of family caregiving in institutional settings

PURPOSE

This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities.

DESIGN AND METHODS

We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression.

RESULTS

Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident-caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors.

IMPLICATIONS

These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes.

Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility

AIM OF THE STUDY

The purpose of this study is to explore the needs of stroke patients' relatives during the hospitalization period.

BACKGROUND

In the Netherlands, the consequences of a stroke, and the needs of stroke patients and their relatives are becoming increasingly important. In hospital, however, nursing care is still focused on the patients. A previous qualitative study on the needs of relatives of stroke patients identified four categories of needs. This present study aims to test the results of the previous study in a larger setting and to identify the factors that influence the needs of the relatives.

DESIGN/METHODS

This study uses a cross-sectional design. A questionnaire was designed for the purpose of data collection. This questionnaire was completed by 106 relatives of stroke patients admitted to the neurology wards of 19 Dutch hospitals (response rate 64%). The data were analysed using descriptive and multivariate analyses.

RESULTS/FINDINGS

The findings of the study indicate that the needs of the relatives of stroke patients are best divided into three categories. These are the need for information, counselling (a combination of communication and support) and accessibility. In all cases, the most important need of the relatives of stroke patients is that their questions are answered honestly. The findings show a discrepancy between the importance of the needs and the degree to which these needs are met. Multivariate data analyses show that female relatives requested most information, whereas highly educated relatives needed less counselling. Satisfaction about the care provided is positively influenced by the period of hospitalization and negatively influenced by prior experiences of hospitalization.

The impact of family environment and decision-making satisfaction on caregiver depression: a path analytic model

OBJECTIVES

This research examines caregiver depression in the context of traditional care-related primary stressors, such as the caregiving context and care-recipient impairment, and secondary stressors, such as family environment and decision-making satisfaction.

METHODS

The authors examine a causal (path) model of depression among 244 caregivers. Ordinary least squares regression results are used to determine the direct and indirect effects of stressors on caregiver depression.

RESULTS

The path coefficients obtained show that adaptability and conflict have the most powerful net effects. With the caregiving context variables, they explain approximately 30% of the variance in decision-making satisfaction. Family adaptability and decision-making satisfaction also have significant paths. The caregiving context, network, family environment, and decision-making variables explain approximately 25% of the variance in caregiver depression.

DISCUSSION

These findings suggest that practitioners working with caregivers to ameliorate depression need to examine the broader aspects of family environment and caregiver perceptions related to decision making.

Couples dealing with cancer: role and gender differences regarding psychological distress and quality of life

The goal of the present study was to further knowledge on gender and role (i.e. patient versus partner) differences in psychological distress and quality of life as a consequence of dealing with cancer. There is some evidence that being the patient or the caregiver makes more difference for men than for women. In total, 173 couples facing various forms of cancer (two samples) and a control group of 80 couples completed the CES-D and Cantril's Ladder. Analyses of variance revealed that both female patients and female partners of patients perceived more psychological distress and a lower quality of life than women in healthy couples. In contrast, role did have an effect on men. Specifically, male patients scored as high on psychological distress and as low on quality of life as female patients and female partners, but psychological distress and quality of life did not differ between male partners of patients and their healthy controls. However, this effect was found in only one patient sample. The finding that female partners perceived more psychological distress and a lower quality of life than male partners could not be accounted for by differences in the physical condition of the patient or the partner.

Hospitalized elders: the difficulties families encounter

1. Family members encountered difficulties when an elder was hospitalized for an acute episode of a chronic illness. 2. It is important for nurses to recognize the kinds of difficulties that family members experience and develop strategies to alleviate them. 3. Failure to include family members in discharge planning can place elders at risk for readmission to the hospital.

Stroke patients in long-term care--the relatives' conception of functional capacity and appropriate care

The closest relatives of 29 permanently institutionalized stroke patients were interviewed about their relationship to the patient before and after stroke, the functional ability of the patient before and after stroke, and their opinion of an appropriate care setting for the patient. The patients had all been independent before stroke, but were now dependent on help with most primary activities of daily living. Twelve patients had severe communicative difficulties. Most relatives could not suggest a realistic alternative to nursing home care, due to the patients' severe disabilities and extensive need for care. One patient was, however, later discharged to a sheltered living facility in accordance with her relative's wishes. One-third of the relatives expressed need for more information and support and wanted to take part in a support group. The nursing staff need high competency in providing good care for the patients and offering psychological support to the relatives, and should include the relatives in the overall treatment plan.