Informal caregiving and its impact on health: a reappraisal from population-based studies

Potential Harmful Behavior Toward Older Family Members: Applying a Double-ABCX Model to Examine Problematic Family Caregiving

Grounded in Lin and Giles' communication model of elder abuse and neglect and McCubbin and Patterson's double-ABCX model of family stress, this study examined whether caregiver self-efficacy and perceptions of positive caregiving outcomes predicted caregivers' lowered tendency to engage in potential harmful behaviors (PHB) toward care receiver directly or indirectly through lowered reports of care receivers' problem behaviors and negative coping strategy (i.e., communication neglect coupled with expressed anger). These expectations were tested through structural equation modeling of survey responses of 339 family caregivers in the U.S. Model results identified "negative coping strategy" as a strong mediating variable for the effects of reports of care receivers' problem behaviors on PHB. A serial mediation path from higher caregiver self-efficacy to lowered reports of care receivers' problem behavior, to reduced use of "negative coping strategy" and finally to reduced PHB was significant. Perceptions of positive caregiving outcomes did not yield similar results.

Cardiovascular disease risk among Australian unpaid carers - A survival analysis using 15 waves of the HILDA survey

BACKGROUND

Engaging in chronically stressful behaviours has been hypothesised to increase the risk of experiencing cardiovascular disease (CVD). Providing unpaid care is known to be a stressful activity, but it is not clear whether this caregiving is associated with CVD. This study filled a gap in the existing literature by examining the association between providing unpaid care and incident cardiovascular disease among a nationally representative sample of Australian adults.

METHODS

11,123 adult participants aged over 18 years from the Household Income and Labour Dynamics in Australia (HILDA) survey were followed for up to 14 years from baseline (2003) until 2017. Gender-stratified survival analysis models used self-reported caregiving and heart disease statuses as well as time-varying covariates, to assess the association between providing high-intensity or low-intensity unpaid care (to an elderly or disabled relative) and incident CVD in comparison with a non-caregiving control.

RESULTS

Among females, there was weak evidence that CVD was associated with high-intensity unpaid care (HR = 1.27, 95% CI = [0.83, 1.95]) and no evidence for low-intensity unpaid care (HR = 0.79, 95% CI = [0.50, 1.26]) in comparison with non-carers after adjusting for confounders. There was no association between caregiving and incident CVD for high-intensity (HR = 0.82, 95% CI = [0.47, 1.42]) or low-intensity (HR = 0.84, 95% CI = [0.55, 1.28]) caregiving males in the adjusted models.

CONCLUSIONS

These findings do not provide strong evidence to reject the null hypothesis that providing unpaid care does not increase risk of developing CVD in the Australian population. Given that these findings are somewhat inconsistent with the extant literature from other populations, further research is necessary, both in Australia and internationally, to build on the findings of this study and improve understanding of the nature of the association between caregiving and incident CVD.

Exploring the Meaning of Collaboration in Rural Mental Healthcare Delivery From the Perspective of Mental Health Clinicians and Informal Carers of People Living With a Mental Health Illness-A Qualitative Study

Mental health policies and practice guidelines emphasise the importance of collaboration with informal carers of people with mental illness, but this does not routinely occur in practice. Understanding the perspective of different parties regarding collaboration is a step towards ensuring an alignment between policy and routine clinical practice. This study explored the meaning of collaboration from the perspectives of informal carers and mental health clinicians in a rural Australian mental health service. This qualitative descriptive study used purposive sampling to recruit informal carers (n = 7) and mental health clinicians (n = 14) from an acute mental health inpatient facility. Data was generated from focus groups and semi-structured interviews and analysed using thematic analysis. Three overarching themes were identified: three-way partnership, purposeful exchange and communication is everything. Clinician and informal carer participants described collaboration as a respectful partnership that necessarily involves the consumer, their carers and clinicians. The purpose of the partnership was identified as providing holistic care to the consumer, which essentially includes support for their carer. Open and clear communication, as well as information sharing, were identified as important to collaboration. However, the experiences of informal carers did not reflect this description of collaboration. Adequate support for informal carers, recognition of their expertise and open and consistent communication are key to a collaborative process that delivers better outcomes for consumers and their carers. Proactive clinician training and a practical guide to inform the delivery of routine informal carer engagement in mental health services are required to achieve an effective three-way collaboration.

MeDeMSA care study protocol: developing personalized best medical care with integrated mobile palliative and telemedicine support for individuals with multiple system atrophy

Multiple system atrophy (MSA) represents a management challenge due to its variable clinical presentation, and lack of established multidisciplinary care protocols. In advanced stages, physical barriers often prevent access to specialized care, leaving patients and caregivers to face complications and fear alone. This 18-month, monocentric, open-label study evaluates the impact of a personalized, multidisciplinary treatment, integrating mobile palliative care, on the quality of life (QoL, measured by EQ-5D-5L indices) of MSA individuals compared to a matched historical European MSA cohort. Forty-six participants will undergo baseline clinical, psychological, and neuro-rehabilitation assessments, along with an online interview to identify individual healthcare preferences. These assessments will guide personalized therapeutic plans, including palliative care, self-directed physio-, speech, and occupational exercises, based on operational protocols informed by evidence and good clinical practice. Six-, 12-, and 18-month follow-ups will reassess needs and adapt plans to address disease progression and changing preferences, ensuring continuous personalization. Repeated interviews at month-12, phone-calls and satisfaction surveys at month-1, 7, 13, and 18 will monitor compliance, identify barriers, and gather feedback. A subgroup of 23 participants will be block-wise randomized to additionally receive monthly and on-demand telemedicine visits for tailored support. Informal caregivers will join an 18-month observational study assessing their QoL and burden through repeated evaluations, offering insights into evolving challenges. We expect that multidisciplinary, patient-centered care with integrated mobile palliative and telemedicine support helps to warrant continuity of care and improve the QoL of MSA individuals throughout the disease course. Its acceptance, safety, and cost-effectiveness will be also assessed.

Relational Maintenance Behaviors Mediate the Relationship Between Alzheimer's Diagnosis Severity and Caregivers' Benefit Finding

Caregivers often experience stress, depression, anxiety, and various physical illnesses stemming from the demands and challenges of their caregiving role. However, adaptive coping mechanisms such as benefit finding can mitigate these outcomes. The present study explored the relationship between Alzheimer's diagnostic severity and caregivers' engaging in benefit finding and, more specifically, whether prosocial relational maintenance behaviors communicated by the patient to the caregiver mediates the relationship between severity and benefit finding. A sample of 152 current or former Alzheimer's caregivers completed an online survey measuring their care recipient's Alzheimer's diagnostic severity, their own propensity for benefit finding, and how often the care recipient performed relational maintenance behaviors toward them as the caregiver. Results showed no direct effect existed between Alzheimer's diagnostic severity and caregivers' benefit finding; however, the extent that patients performed relational maintenance behaviors with their caregiver mediated the relationship between Alzheimer's diagnostic severity and caregivers' benefit finding. The significant influence of relational maintenance behaviors underlines the importance and effect of communication between caregivers and care recipients throughout the progression of a disease like Alzheimer's.

Psychometric validation and cultural adaptation of the Chinese version of the CarerQol-7D instrument

OBJECTIVE

This study aims to translate and validate the CarerQol in a sample of informal caregivers in China.

METHOD

The CarerQol was translated following a standard process. Validation data was collected from multiple sources, including hospitals, patient associations, and community health centers between September 2023 and December 2024 in China. Caregivers of individuals with disability or long-term care needs were recruited. The psychometric properties of the CarerQol-7D were evaluated through ceiling and floor effects, factorial structure, convergent and divergent validity, known-groups validity, and test-retest reliability.

RESULTS

A total of 324 participants completed the survey and provided validated responses. The mean CarerQol level sum score was 12.8 (SD = 2.9). The CarerQol-7D showed no ceiling or floor effects at either dimension or scale levels. Test-retest reliability of the CarerQol-7D was satisfactory, as supported by ICC and Gwet's AC1 measures. Correlation analysis confirmed all hypothesized pairs of dimensions and level sum scores/utility scores between CarerQol-7D, SF-6Dv2, and ICECAP-A. The CarerQol-7D successfully distinguished between risk groups through ANOVA testing. Confirmatory factor analysis revealed that a one-factor model of the CarerQol-7D fit the data.

CONCLUSION

This study provides the Chinese version of the CarerQol and confirms its sound psychometric properties for informal caregivers in China. These findings demonstrate the CarerQol's value in cost-effectiveness analyses of caregiving interventions and strategies.

Psychometric properties of the polish version of the Dysfunctional Thoughts about Caregiving Questionnaire (DTCQ)

Dysfunctional thoughts about caregiving are defined as rigid and inappropriate interpretations of one's experiences, behaviors, thoughts, or feelings that are associated with providing care to a dependent relative. The present study examined the psychometric properties of the Polish adaptation of the Dysfunctional Thoughts about Caregiving Questionnaire (DTCQ). DTCQ was administered to 618 family caregivers of people with chronic health problems. As the Confirmatory factor analysis supported both one and two-factor structure of the DTCQ, following the principle of parsimony, one-factor model was considered more appropriate. Construct validity was also supported by significant and theoretically expected relationships between DTCQ and depression, identity formation or sociodemographic variables. In conclusion, this study is the first to provide preliminary evidence for the reliability and validity of the DTCQ as a measure of dysfunctional thoughts in Polish family caregivers.

Caregivers' impact in heart failure: a cross-sectional study

OBJECTIVES

Caregivers play a pivotal role in supporting patients with heart failure (HF). Caregiving may be associated with significant impact on the caregivers' health. This study aimed at exploring the impact of caregiving in relation to self-rated health, anxiety and depression compared with the general Danish population.

METHODS

A cross-sectional exploratory study was conducted with caregivers of adult patients with HF New York Heart Association (NYHA) II, III and IV from the Department of Cardiology at the North Zealand Hospital in Denmark. Patients with HF were asked to indicate the caregiver ≥18 years to participate. Assessment of caregivers included the Zarit Burden Interview, Patient Health Questionnaire-4 and the 36-item Short-Form Health Survey.

RESULTS

Of 127 included caregivers, 119 completed the questionnaire (96 women). The mean age was 67 years (range 28-87 years). Overall, 31% of caregivers found caregiving burdensome. The heaviest burden was found in caregivers of patients with the highest symptom burden and NYHA class (p=0.005). Caregivers had 1.63 (95% CI: 1.00 to 2.66) times higher odds of reporting signs of anxiety than individuals in the general population. However, caregivers had 1.88 (95% CI: 1.09 to 3.25) times higher odds of rating their health as good than the general Danish population.

CONCLUSIONS

Our finding of a higher proportion of caregivers reporting good health compared with the general population is in keeping with other recent studies. However, educational and supportive interventions supporting caregivers in providing care while maintaining their own health should still be considered.

The impact of unpaid caring on cognitive function: a rapid review

OBJECTIVES

Our review aimed to examine the role of unpaid care in influencing cognitive function independently or via risk factors for dementia.

METHOD

This rapid review, registered in PROSPERO and following PRISMA guidelines, searched EMBASE, MEDLINE, and APA PsycINFO databases for longitudinal studies comparing dementia, cognitive function and associated risk factors for dementia between carers and non-carers. Studies were assessed for quality. Data were synthesised narratively.

RESULTS

Five studies looked at cognitive function directly; others examined risk factors: depression, social isolation, physical activity, body-mass index, type 2 diabetes, high blood pressure, educational attainment, and alcohol consumption. Unpaid carers have increased risk of depression and social isolation, and younger carers have lower educational attainment. Studies evaluating the link between unpaid caring and cognitive decline suggest that caring at low and moderate intensities may act as a protective factor against cognitive decline, but not at higher intensities. Female gender and high-intensity caring significantly influence the strength of association between unpaid care and dementia risk factors.

CONCLUSION

The impact of unpaid caring on cognitive health is complex, influenced by factors like intensity of care and social and cultural context. Across all studies, high-intensity caring negatively impacts carers physical and mental health, which in turn affect their cognitive health.

Race Differences in Purpose in Life Among Family Caregivers: Findings From the Caregiving Transitions Study

Family caregiving may affect purpose in life, defined as the sense that life has meaning and intentionality. Few studies have compared caregivers to non-caregivers or examined the characteristics of caregivers associated with purpose in life. Using data from the Caregiving Transitions Study (n = 486), we conducted multiple linear regression analyses to test the effects of caregiver status, age, gender, social network, and physical and mental health on purpose in life. We also tested whether the effect of caregiver status differed by race and, among caregivers (n = 241), the associations between caregiving characteristics and purpose in life. Caregivers did not differ significantly from non-caregivers in purpose in life in adjusted analysis. Among caregivers, significantly greater purpose of life was observed among Black caregivers and those reporting higher positive aspects of caregiving. Future research should examine these issues longitudinally, and caregiver interventions should consider addressing purpose in life and positive aspects of caregiving.

An Integrative Review of the Support Needs of Informal Caregivers of Hematological Cancer Patients in the Period Immediately Following Discharge From Inpatient to Outpatient Care

BACKGROUND

Preparing informal caregivers for a patient's transition to outpatient care is an important component of safe, quality hematological cancer care. The development of many novel therapies and emerging treatments has created opportunities to address the needs of informal caregivers following the discharge of patients from inpatient settings.

OBJECTIVE

To review and synthesize the literature on the needs of informal caregivers of patients with a hematological malignancy postdischarge from inpatient care.

INTERVENTIONS/METHODS

Integrative review methodology was used to explore the body of evidence available. This included a quality appraisal of qualitative, quantitative, and mixed-methods research findings, subsequent data extraction, and inductive thematic synthesis.

RESULTS

One thousand eight articles were screened with 10 included in the review. Key insights into the needs of caregivers entering the outpatient setting were identified and grouped into key subheadings: Encountering complex emotions knowing what to know, little time for yourself, and collateral impact.

CONCLUSION

Findings convey the complex and multiple needs of informal caregivers of hematological cancer patients. With a growing population of people with hematological malignancies and innovations in outpatient cancer therapies, there is a pressing need to codesign interventions to support their caregivers.

IMPLICATIONS FOR PRACTICE

This review has identified a need for more robust research to coproduce interventions in collaboration with caregivers. In addition, interventions developed from further research should be tested in quality implementation science studies to determine their feasibility, sustainability, and impact on outcomes that matter to hematological cancer caregivers.

Spousal Caregiving Types and Cognitive Trajectories Among Middle-Aged and Older Adults in China

Objectives: This study investigates the longitudinal association between spousal caregiving types and cognitive trajectories among middle-aged and older Chinese adults, with a focus on gender differences. Method: Data from the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018) were analyzed, covering 4568 couples aged 45 and above. Caregiving types were Activities of Daily Living (ADLs) caregiving, Instrumental Activities of Daily Living (IADLs) caregiving, and both ADLs/IADLs caregiving. Cognitive function was assessed using tests of memory, orientation, numeric ability, and visuospatial ability. Latent growth curve modeling was used to examine associations between caregiving types and cognitive trajectories. Results: Spouses who only provided IADLs caregiving had slower cognitive decline compared to those who did not provide caregiving, regardless of gender. However, those who provided ADLs caregiving had faster cognitive decline compared to non-caregivers, especially in women. Discussion: These findings highlight the importance of caregiving types as well as the gendered effects of caregiving on cognitive trajectories.

Health literacy interventions for informal caregivers: systematic review

AIM

The aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.

METHODS

MEDLINE, CINAHL, PsycINFO and Embase were searched for relevant literature. Articles were included if they focused on adults who provided informal care to someone aged 18+ with a chronic disease/disability. Quantitative studies were included if they reported an intervention designed to improve caregiver health literacy (CHL) and assessed outcomes using a validated measure of health literacy. Qualitative and mixed method studies were included if they described a conceptual model or framework of CHL or developed/assessed the feasibility of an intervention. Study quality was appraised using the Mixed Methods Assessment Tool.

RESULTS

Eleven studies were included. Five studies used pre-post design to assess outcomes of an intervention; four described intervention development and/or pilot testing; two described conceptual models. Two of five studies reported pre-post intervention improvements in CHL; one reported an improvement in one of nine health literacy domains; two reported no improvements following intervention. Interventions predominantly aimed to improve: caregiver understanding of the disease, treatment and potential outcomes, day-to-day care, self-care and health provider engagement. Few interventions targeted broader interpersonal and health service factors identified as influencing CHL.

DISCUSSION

Evidence on the development and assessment of comprehensive CHL interventions is scarce. Recommendations include the development of interventions that are guided by a CHL framework to ensure they address individual, interpersonal and health service/provider factors that influence CHL.

A cost analysis of reductions in work productivity for MG patients and their caregivers by symptom severity

Introduction

Myasthenia Gravis (MG) is a debilitating autoimmune disorder associated with fatigue and weakness in the ocular, respiratory, bulbar and limb muscles. This study evaluates productivity losses for MG patients and their caregivers by MG symptom severity.

Methods

In the multinational MyRealWorld-MG study, 1,049 MG patients and caregivers reported on work productivity (sick leave, reduced working hours, early retirement). Productivity losses were calculated using the average wage per hour. A UK perspective was adopted for the whole sample, and country-specific analyses were conducted for Italy, Spain and the US. The MG-Activities of Daily Living (MG-ADL) score was used to estimate the association between symptom severity and productivity losses, with patients categorized as having mild (0-4), moderate (5-9), or severe (> = 10) symptoms.

Results

In the MyRealWorld-MG study, 36.5% of MG patients reported taking sick leave within the last month and 11.4% reported stopping work (or retiring early) due to MG. Furthermore, 36.0% required caregiver support with 14.6% of caregivers reducing working hours and 13.4% stopping work. Mean productivity losses were £16,630/year for patients and caregivers combined, largely attributable to patient productivity losses (£13,891). Patients with severe MG incurred 3.8 times more productivity losses compared to patients with mild disease. Productivity loss estimates varied between Italy, Spain and the US.

Conclusion

The impact of MG on patients' and caregivers' work productivity leads many of them to reduce work hours or retire early, resulting in significant productivity losses. The magnitude of these productivity losses is correlated with symptom severity and varies by country.

Family Caregiver Perspectives on Digital Methods to Measure Stress: Qualitative Descriptive Study

BACKGROUND

Family caregivers provide essential care in the home to millions of individuals around the globe annually. However, family caregiving results in considerable burden, financial hardship, stress, and psychological morbidity. Identifying and managing stress in caregivers is important as they have a dual role in managing their own health as well as that of the person they care for. If stress becomes overwhelming, a caregiver may no longer be able to perform this essential role. Digital methods of stress monitoring may be 1 strategy for identifying effective interventions to relieve caregiver burden and stress.

OBJECTIVE

This study aims to explore the perceived acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress.

METHODS

We conducted a descriptive qualitative study using semistructured interviews with an interview guide structured to obtain qualitative data addressing our study aims. We used reflexive thematic analysis methods. We recruited adult family caregivers (aged 18 years and older) currently or previously caring for an adult in the home with significant health issues. Interview questions focused on stress monitoring more generally and on ecological momentary assessment, remote monitoring technologies such as smartwatches, and fluid biosensors.

RESULTS

We recruited 27 family caregivers of whom 19 (70%) were currently in a caregiving role, and the remainder were previously in a caregiving role. We identified 3 themes with 10 subthemes addressing elements of acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress The themes comprised "providing meaningful data" with subthemes of "monitoring without action is pointless," "monitoring that enables self-management," and "seeing the bigger picture"; "low-burden monitoring" with subthemes of "low effort," "practical alongside daily routines," and "retaining control over monitoring"; and "inadvertent harms of stress monitoring" with subthemes of "stigma of stress," "need for discretion," "contributing to stress," and "trust."

CONCLUSIONS

In this descriptive qualitative study examining the perspectives of a diverse sample of family caregivers on methods of stress monitoring, we identified 3 themes addressing elements of acceptability, challenges, and opportunities. These provide useful considerations for the use of stress monitoring and implementation of interventions to ameliorate family caregivers' stress of relevance to social care and community teams, researchers, and policy makers. These include providing meaningful situationally specific data resulting in action, that does not contribute to caregiver burden, or inadvertent harm to either the caregiver or the care recipient.

Deterioration of health-related quality of life: the hidden health burden of informal caregiving

Informal caregiving is physically and mentally demanding and may lead to poor health and impaired well-being. We aim to check the effects of informal caregiving on health-related quality of life (HRQoL). We utilised longitudinal data from the most recent sixteen waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We measured HRQoL through the physical component summary (PCS), the mental component summary (MCS), the short-form six-dimension (SF-6D) utility index, and the eight dimensions of the SF-36 health survey. The primary exposure variable is informal caregiving. The variable was categorised into not a caregiver, lighter (< 5 hours [h]/week), moderate (5-19 h/week), and intensive (≥ 20 h/week) caregiving based on the hours of providing informal care per week. We have found that informal caregiving negatively affects HRQoL. We found that moderate (β = -0.0035, standard error [SE] = 0.0012) and intensive caregiving (β = -0.0074, SE = 0.0020) reduced SF-6D utility value. We also found that lighter (β = -0.29, SE = 0.07), moderate (β = -0.55, SE = 0.12), and intensive (β = -1.53, SE = 0.19) caregiving lowered MCS scores. Moreover, our results revealed that lighter, moderate and intensive caregiving decreases the scores of mental health-related dimensions (e.g., role emotional, social functioning, and mental health) of the SF-36 health survey. Our study findings have significant policy implications for improving the HRQoL and well-being of caregivers. To effectively support the health and well-being of informal carers, it is crucial to implement strategies that address their diverse needs, including supporting work-life balance, providing financial assistance and social security measures, ensuring access to community-based services, providing access to relevant information and training, and offering respite care options.

The mediating role of social support on the link between adverse childhood experiences and adult mental health

Adverse childhood experiences (ACEs) have been associated with adult mental health, especially anxiety and depression. We aimed to explain these relationships by investigating perceived social support as a mediating factor. In this model, it is proposed that individuals who experience more ACEs will have less perceived social support in adulthood, which in turn will increase reported anxiety and depression symptoms. Data were collected on ACEs, anxiety, depression, and perceived social support using an anonymous REDCap survey distributed through various social media outlets and relevant listservs. Respondents (N = 494) were caregivers who primarily resided in the United States and identified as White, well-educated, middle class, and female. ACEs were measured using the expanded ACE questionnaire extracted from the Health-Resiliency-Stress Questionnaire. Anxiety and depression were measured by the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire 9-item scale, respectively. Social support was measured with the Multidimensional Scale of Perceived Social Support. Results confirmed partial mediating effects of social support on the relation between (a) ACEs and anxiety and (b) ACEs and depression. Increased exposure to ACEs was associated with less social support in adulthood and, consequently, to greater mental health symptomatology. Implications of these findings highlight the potential role of social support as a preventative strategy and adult social support as a mitigating strategy.

Stress as a Risk Factor for Informal Caregiver Burden

Background/Objectives: Informal caregivers, who provide essential support to dependent family members, often face high levels of stress and mental health problems due to the physical and emotional demands of the role. This study examined the connections between anxiety, depression, stress, and caregiver burden in informal caregivers. Methods: A total of 344 informal caregivers from the Valencian Community, selected by incidental sampling, took part. A total of 58.7% were female (n = 202) with a mean age of 46.37 years (SD = 14.79), while 41.3% were male (n = 142) with a mean age of 46.37 years (SD = 14.78). This study used the DASS-21 and the Zarit Burden Questionnaire. Data analysis was by structural equation modeling with latent factors. Results: The principal findings indicated that anxiety and depression were predictive factors for stress (p = 0.006, p = 0.002 respectively), while stress, in turn, was associated with a higher caregiver burden (p < 0.001). Conclusions: Anxiety and depression indirectly heighten caregiver burden through increased stress.

Mental health of informal caregivers during the COVID-19 pandemic: a Swiss cohort study

AIMS OF THE STUDY

The COVID-19 pandemic and related public health measures have disrupted healthcare systems and may have impacted informal caregivers' mental health due to increased responsibilities and limited access to support services. This study aimed to examine the prevalence of mental distress among caregivers and non-caregivers and identify risk and protective factors for mental distress in caregivers during the COVID-19 pandemic.

METHODS

Data were collected from participants in Specchio-COVID19, a population-based cohort in Geneva, Switzerland. Mental distress was measured using the 12-item General Health Questionnaire (GHQ-12) in June 2021. The prevalence of distress was compared between caregivers and non-caregivers. Risk and protective factors for mental distress among caregivers were explored using logistic regressions.

RESULTS

Among the 5416 participants, 1086 (20%) reported helping someone in a non-professional manner with activities of daily life and were considered caregivers. Mental distress was more frequent in caregivers than in non-caregivers (41% vs 37%, p = 0.010). In caregivers, limited social support (adjusted odds ratio [aOR] = 1.25 [95% confidence interval: 1.10, 1.42]), caring for an individual with a mental condition (aOR = 1.21 [1.05, 1.41]), living over 10 km away from the care recipient (aOR = 1.17 [1.02, 1.34]), feeling more isolated in one's caregiving role (aOR = 1.20 [1.08, 1.32]), worrying about caregiving ability in case of COVID-19 or quarantine (aOR = 1.18 [1.08, 1.28]) and experiencing reduced availability of healthcare professionals (aOR = 1.11 [1.02, 1.22]) were associated with increased odds of mental distress.

CONCLUSION

Informal caregivers experienced higher levels of mental distress than non-caregivers during the COVID-19 pandemic. This study highlights the need for public health policies that enhance both formal and informal support networks and include rapidly implementable solutions for caregiving continuity, benefiting both caregivers and their care recipients.

Identifying, Engaging, and Supporting Care Partners in Clinical Settings: Protocol for a Patient Portal-Based Intervention

BACKGROUND

In the United States, the landscape of unpaid care delivery is both challenging and complex, with millions of individuals undertaking the vital role of helping families (broadly defined) manage their health care and well-being. This includes 48 million caregivers of adults, 42 million of whom are caregivers of adults aged 50 years or older. These family care partners provide critical and often daily support for tasks such as dressing and bathing, as well as managing medications, medical equipment, appointments, and follow-up care plans.

OBJECTIVE

This study aimed to implement a novel patient portal-based intervention to identify, engage, and support care partners in clinical settings.

METHODS

The project team collaborated with 3 health care organizations (6 primary care practices in total) to design and implement a patient portal-based intervention. Three days in advance of a visit, patients were invited to log on to their patient portal account and answer a brief questionnaire as part of the routine electronic check-in process asking them to (1) identify themselves as the patient or someone answering for the patient, (2) report major life changes, (3) set the agenda for the upcoming visit, and (4) report on care partner responsibilities. Respondents' answers to this brief questionnaire were available to providers ahead of the visit. Patients with care partner responsibilities, as well as care partners answering the questionnaire on behalf of patients, were provided a link to the ARCHANGELS Caregiver Intensity Index to measure the intensity of their caregiving role and motivate care partners to connect with suggested state and local resources.

RESULTS

The intervention was launched in September 2022 at Organization A. Organization B launched in May 2023 in one clinic and June 2023 in the other. In focus groups, staff and clinicians reported that the intervention was easy to implement and did not cause workflow disruption. At 6 months post implementation, across both organizations, a total of 22,152 patients had received questionnaires and 13,825 (62.4%) had submitted completed questionnaires. Full data will be reported at the completion of the intervention period.

CONCLUSIONS

Early results suggest that the intervention could be an easily scalable and adaptable method of identifying and supporting care partners in clinical settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66708.

Informal Caregiving: Health System Cost Implications

BACKGROUND

Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system.

OBJECTIVE

We examined the impact of caregiving on costs associated with caregivers' use of publicly funded health care services in Ontario, Canada, in comparison with non-caregivers.

METHODS

We included Ontarians who participated in the Canadian Community Health Survey-Healthy Aging Supplement Survey of 2008/09 and linked responses to health care administrative databases. A difference-in-differences design was used to capture differences in caregivers' and non-caregivers' total health care costs 1 and 2 years before and after caregiving start date. Generalized Linear Models were used to model the total health care costs.

RESULTS

The sample size was 4275 with 1265 caregivers and 3010 non-caregivers. We found that while health care utilization increased over time, it increased by a lesser amount for caregivers than non-caregivers. Adjusted total health care costs for caregivers were 11.32% (SE = 0.05, ρ = 0.02) lower than non-caregivers 2 years into caregiving.

CONCLUSIONS

Our study reveals a critical gap in policy, practice, and research driven by a lack of routine data collection and caregiver identification. It also highlights the need for additional longitudinal research focusing on caregivers' objective health.

Exploring Social Inequalities in Post-pandemic Labour Market Shifts and Job Dissatisfaction in Barcelona: Insights From a Southern European City

The COVID-19 pandemic exacerbated labour market inequalities, disproportionately affecting low-paying, precarious jobs and vulnerable groups, while also accelerating shifts such as telecommuting, which had mixed impacts on job satisfaction. This study aimed to assess social inequalities in changes in the labour market as well as job dissatisfaction among workers in the city of Barcelona between 2016 and 2022. A comparison of two population-based cross-sectional studies was carried out, using data from the Barcelona Health Surveys (BHS) of 2016-17 and 2021-22. Data sampling was weighted to ensure representativeness. A descriptive analysis was carried out for sociodemographic and work-related variables and multivariate weighted linear regressions were adjusted by potential confounders between year of the sample and job dissatisfaction. Job status improved and job dissatisfaction decreased in both sexes between 2016 and 2022. Having a non-manual job entailed a decrease in job dissatisfaction for women and men (-0.09; 95% CI -0.16 to -0.03 and -0.10; -0.16 to -0.04 respectively). Among women born outside Spain, job dissatisfaction increased (0.09; 0.02 to 0.16). Job dissatisfaction decreased among men with a full-time contract (-0.11; -0.21 to -0.02). In both sexes, having no contract was associated with an increase in job dissatisfaction. There were improvements in the labour market of Barcelona. Job dissatisfaction decreased, but not among migrant women or individuals with manual jobs and precarious contractual situations. Policies developed in recent years might have mitigated the negative effects of COVID-19 on the labour market.

The Role of Life Satisfaction and Optimism for Successful Aging in Mid and Late Life

Guided by the Rowe and Kahn model, the current study examined the longitudinal association of objective and subjective components of successful aging (SA) with individuals' life satisfaction and level of optimism across adulthood aiming to validate the related scanty existing research. Data were from waves 2 and 3 (2004-14) of the Midlife in the United States (MIDUS) study. Using structural equation modeling, we examined (N = 2,040) whether subjective life satisfaction (wave 2) has any effect on a composite measure of SA (wave 3) while controlling for baseline sociodemographic and health factors. We also examined the mediation effects of optimism in the above associations. Findings revealed that life satisfaction has a significant positive effect on SA; also, this effect is bidirectional. Further, high optimism positively mediated the bidirectional association between life satisfaction and SA. This study identified life satisfaction and optimism as having potentially positive impacts on achieving SA in middle-aged and older adults.

Building a social support network for informal caregivers of older adults: A case study of Carer Cafés in Hong Kong

This study addresses the social care issue of supporting older adults' informal caregivers at the community level. It assesses how community café initiatives, particularly the Carer Café project by the Hong Kong Federation of Women's Centres (HKFWC), develop support networks and enable access to embedded social capital. Utilizing the organizational brokerage model, this research analyzes the network characteristics formed around informal caregivers within the café. This qualitative study employs individual in-depth interviews, focus groups, and observations to collect data. We interviewed 26 informants and observed the operation of five Carer Cafés. Key findings indicate that support networks are deeply integrated with the organization's norms, influencing social interactions in terms of frequency, duration, outward focus, and collaboration. Caregivers benefit from various forms of social capital derived from the Carer Café's networks, which provide enduring support beyond the café setting. While the support networks have extended to the community, they remain embedded in the organization. This embeddedness helps staff take note of caregivers' situations and facilitates the flow of assistance from organizations to caregivers. The study highlights the importance of organizational embeddedness in shaping support networks, offering insights for improving caregiver services and informing policy development.

Understanding Challenges and Emotions of Informal Caregivers of General Older Adults and People With Alzheimer Disease and Related Dementia: Comparative Study

BACKGROUND

Faced with multiple challenges, informal caregivers often turn to online support communities for information and support. While scholarly attention has focused on experiences expressed by informal caregivers in these communities, how caregivers' challenges and emotional expressions vary across different health contexts remains understudied.

OBJECTIVE

We aimed to examine and compare the challenges discussed by informal caregivers of general older adults and those of patients with Alzheimer disease and related dementia, as well as their emotional expressions, on Reddit. In addition, we examined how informal caregivers expressed their emotions in response to various challenges.

METHODS

We collected posts from 6 subreddits, including 3 subreddits on caregiving for older adults and 3 on caregiving for patients with Alzheimer disease and related dementia. Using topic modeling, we identified topics discussed by caregivers in the collected posts. We further used deep reading to contextualize these topics and understand the challenges behind them, conducted sentiment analysis to investigate their emotional expressions, and used Spearman rank-order correlation to examine the relationship between the obtained topics and emotions.

RESULTS

In total, 3028 posts were retrieved, including 1552 from older adult-related subreddits and 1476 from Alzheimer disease-related subreddits; 18 key topics were identified, with the most frequent topics being expressing feelings (2178/3028, 71.93%) and seeking advice and support (1982/3028, 65.46%). Other topics covered various challenges in caregiving, such as duration of medical care (1954/3028, 64.53%), sleep and incontinence (1536/3028, 50.73%), financial issues (1348/3028, 44.52%), and nursing home (1221/3028, 40.32%). There was a positive, negligible correlation between expressing feelings and seeking advice and support (ρ=0.09, P<.001). Other topics also showed positive, negligible or weak correlations with these 2 topics but in distinct patterns. Posts from older adult-related subreddits were more focused on practical caregiving issues and seeking advice and support, whereas posts from Alzheimer disease-related subreddits emphasized health- and medical-related topics and expressing feelings. Caregivers in both contexts predominantly expressed negative emotions (older adults: 1263/1552, 81.38%; Alzheimer disease: 1247/1476, 84.49%), with caregivers in Alzheimer disease-related subreddits exhibiting slightly greater fear and sadness (P<.001). Specific challenges were significantly correlated with negative emotions: duration of medicalcare was positively, weakly correlated with anger (ρ=0.25, P<.001), fear (ρ=0.25, P<.001), and sadness (ρ=0.22, P<.001). Medical appointments were positively, negligibly correlated with anger (ρ=0.10, P<.001), fear (ρ=0.09, P<.001), and sadness (ρ=0.06, P<.001). Sleep and incontinence (ρ=0.14, P<.001) and finances (ρ=0.24, P<.001) were positively, weakly correlated with anger.

CONCLUSIONS

By identifying the challenges and feelings expressed by caregivers for general older adults and caregivers for patients with Alzheimer disease and related dementia, our findings could inform health practitioners and policy makers in developing more targeted support interventions for informal caregivers in different contexts.

Family caregivers' role in dignity: A qualitative study can we change the title to : Dignity in Serious Illness: A Qualitative Exploration of Family Caregivers' Contributions in low middle-income country

OBJECTIVES

Dignity is perceived as being valued and respected. Maintaining dignity throughout illness is a fundamental principle of palliative care. Dignity can be influenced through family caregiver's communication, support, and acts of empathy or indifference among other factors. The perception of dignity and the practices adopted by family caregivers to preserve the dignity of their ill relative with serious illness in Lebanon are explored in this paper.

METHODS

This is a part of a larger study that explored the understanding of dignity from patients' and family caregivers' perspectives in a palliative care context. Data collection involved in-depth interviews with 15 family caregivers. Interviews were analyzed using reflective thematic analysis.

RESULTS

Four main themes, that explained how family caregivers understand, and uphold their relative's dignity during illness, were developed:(a) Familial duty expressed through presence and compassion;(b) Holistic care and financial stability;(c) Social connection and family roles;(d) Compassionate services and communication.Family caregivers maintained the dignity of their ill relatives through being there, compassionate communication, supporting the personal and medical needs of the patient, and helping them preserve their family role. Family caregiving was often underpinned by religious values and a sense of duty. Compassionate services and effective communication were essential to preserve dignity of the ill relative during hospitalizations.

SIGNIFICANCE OF RESULTS

Family caregivers assume multiple roles in fostering the dignity of relatives with serious illnesses. It is crucial that family caregivers are supported by policies, healthcare systems, and community initiatives as patients cannot thrive nor sustain dignity without their support.

Development and content validity of the caregiver assisted transfer technique instrument

Informal caregivers often provide transfer assistance to individuals with disabilities; however, repeated transfers are associated with a high risk of musculoskeletal pain and injury, and training and education around transfers is minimal. The purpose of this study was to develop and assess the content validity of a new tool, the Caregiver Assisted Transfer Technique Instrument (CATT), which could be used to provide an objective indicator of transfer performance. Item importance, clarity, and appropriateness of responses were rated on a five-point Likert scale by clinicians (n = 15), informal caregivers (n = 10), and individuals with spinal cord injury (n = 5). The content validity index and modified Kappa of each item was calculated. Participants also provided qualitative feedback on item content. In general, items were rated favorably for their importance (4.47 to 5.00), clarity (4.33 to 4.90), and appropriateness of responses (4.38 to 4.90), and most items had excellent content validity (k* ≥ 0.75). Feedback from participants led to the creation of two versions of the CATT: one for manual lifting techniques (CATT-M) and one for transfers performed via lift-based technologies (CATT-L). Future work will focus on establishing the reliability and validity of the CATT as well as developing training and education interventions surrounding assisted transfers.

Trajectories of Burden or Benefits of Caregiving Among Informal Caregivers of Older Adults: A Systematic Review

Background and Objectives

Informal caregiving for older adults can be both burdensome and beneficial. Given that the informal caregiving situation may evolve over time, and care needs of older adults can result from diverse health conditions, it is valuable to understand the trajectories of burden or benefits of caregiving and how these trajectories vary across health conditions common among older care-recipients. This review is the first to summarize the literature on trajectories of burden or benefits of caregiving, including caregiver and care-recipient characteristics associated with the trajectories.

Research Design and Methods

We reviewed longitudinal observational quantitative studies, from 5 bibliographic databases, that assessed burden or benefits of caregiving at 3 or more time points among informal caregivers of older adults (60 years or above).

Results

The narrative synthesis included 41 studies, with only 7 (17%) considering trajectories of benefits. A stable average trajectory of burden or benefits of caregiving was the most common pattern over time across various care-recipient health conditions. However, an increasing burden over time was primarily observed among caregivers of persons with dementia, while a decreasing burden was noted among caregivers of persons discharged from the hospital after an acute health event. Only 6 (10%) studies, which reported heterogeneity in the progression of burden or benefits separately or jointly, identified distinctive trajectories within the same set of caregivers. Risk factors consistently identified to be associated with trajectories indicating persistently higher burden or persistently lower benefits included more care-recipient functional limitations and behavioral problems, being a non-spousal caregiver, being a solo caregiver, and perceiving less self-efficacy or competence.

Discussion and Implications

Future studies should focus on the trajectories of benefits of caregiving, untangle heterogeneity in trajectories of burden or benefits of caregiving, and consider both burden and benefits concurrently to identify factors that both enhance benefits and alleviate burden over time.

Care burden and quality of life among family caregivers of children with cerebral palsy in China: the mediating roles of social support and coping styles

BACKGROUND

Children with cerebral palsy have substantial caregiving demands, and the overall health of their caregivers is greatly affected. The contributing variables to caregivers' quality of life must be identified. Our attention will be paid to the impact of caregiver's social resources such as social support and caregiver's personal resources such as coping styles on their care situation.

AIMS

To explore the relationships among care burden, social support, coping styles, and QOL of caregivers for cerebral palsy children by mediation effect models.

DESIGN

A cross-sectional study design.

METHODS

The purposive sampling method was used in this study to select 189 caregivers of cerebral palsy children from the rehabilitation department of a children's hospital in western China from May 2022 to August 2023. Self-designed demographic data questionnaire, the WHO's Quality of Life Questionnaire, the Zarit Burden Interview, the Social Support Rating Scale, and the Simplified Coping Style Questionnaire were used for conducting the investigation. Correlations analyses between variables were analyzed using Pearson's correlation coefficient. The mediating effects were explored using the Process Macro and bootstrap method.

RESULTS

Among the 189 caregivers, 59.26% were mothers, 64.55% had received high school or lower education. The majority of caregivers were not employed (62.96%). Care burden had a detrimental impact on both physical QOL and mental QOL. Social support and positive coping style were positively correlated with physical and mental QOL. Among the mediation analyses, significant indirect effects were found for the mediation path of social support between care burden and either physical or mental QOL. Whereas positive coping style as a mediator was not statistically significant. Additionally, social support and positive coping style formed a significant serial mediation path.

CONCLUSION

Caregivers of cerebral palsy children suffer from a certain level of caregiving burden and an unsatisfactory living quality. Social support alone or in combination with positive coping style played mediating roles in connection of care burden and QOL. Future interventional research ought to prioritize boosting social support and developing positive coping style since they may exert the synergistic effect on both physical and mental QOL of caregivers.

Caregiver burden and risk of epithelial ovarian cancer in the Nurses' Health Studies

Psychosocial stress may increase ovarian cancer risk and accelerate disease progression. We examined the association between caregiver burden, a common stressor, and risk of epithelial ovarian cancer. We prospectively followed 67 724 women in the Nurses' Health Study (1992-2012) and 70 720 women in the Nurses' Health Study II (2001-2009) who answered questions on informal caregiving (ie, caregiving outside of work). Women who reported no informal caregiving were considered noncaregivers, while, among women who provided care outside of work, caregiver burden was categorized by time spent caregiving and perceived stress from caregiving. For the 34% of women who provided informal care for ≥15 hours per week, 42% described caregiving as moderately to extremely stressful. Pooled multivariate analyses indicated no difference in ovarian cancer risk for women providing ≥15 hours of care per week compared to noncaregivers (hazard ratio [HR] = 0.96; 95% confidence interval [CI], 0.79-1.18), and no association was evident for women who reported moderate or extreme stress from caregiving compared to noncaregivers (HR = 0.96; 95% CI, 0.75-1.22). Together with prior work evaluating job strain and ovarian cancer risk, our findings suggest that, when evaluating a stressor's role in cancer risk, it is critical to consider how the stressor contributes to the overall experience of distress. This article is part of a Special Collection on Gynecological Cancer.

Predictors of food security status among informal caregivers of older adults residing in slums in Ghana

BACKGROUND

Informal caregivers of older adults play a crucial role, positively influencing the physical, mental, and social well-being of their care recipients, while concurrently contributing to substantial cost savings in the healthcare sector. The significance of food security for these caregivers becomes paramount as it not only impacts their health but also influences the energy needed to fulfil their caregiving responsibilities. Nevertheless, there is a scant literature on the factors that predict food security status among informal caregivers of older adults residing in slum communities in Ghana. This study seeks to address this gap by examining the factors that predict food security status among informal caregivers.

METHODS

A sample of 458 informal caregivers of older adults residing in slum communities in the Greater Kumasi metropolis was used for the study. The Generalized Linear Regression Model was used to estimate factors that predict food security status among informal caregivers of older adults in slum communities. Beta values and standard errors were utilised, with a significance level of 0.05 or lower.

RESULTS

The analysis showed that 88.4% of the participants were females, 37.3% were aged 40-49 years, 72.7% were of Akan ethnicity, 81.4% were married, 45.4% had basic education, 96.3% did not receive pay for caregiving and 72.1% were enrolled in a national health insurance scheme. The study revealed that participants without formal education (β = 0.661, p <.05) and those aged 29 years or younger (β = 26.927, p <.001), 30-39 years (β = 27.453, p <.001), and 40-49 age group (β = 26.710, p <.001) statistically significantly exhibited an increased food security status compared to their counterparts. Additionally, participants identifying as Akan (β = -0.421, p <.05), Christians (β = -0.828, p <.001), married individuals (β = -0.500, p <.05), those who reported never being ill (β = -2.617, p <.001), those without chronic non-communicable diseases (NCDs) (β = -0.638, p <.001), and those not enrolled in the national health insurance scheme (β = -0.422, p <.01) statistically significantly experienced a decreased food security status compared to their counterparts.

CONCLUSION

Considering these findings, policymakers are urged to integrate socio-economic and health characteristics of informal caregivers into food security policies. This inclusive approach is essential for enhancing the food security status of informal caregivers responsible for older adults in slum communities.

Impact of Spousal Mental Illness on Healthcare Utilization Among Patients With Gastrointestinal Cancer

BACKGROUND

Informal caregiving involves increased responsibilities, with financial and emotional challenges, thereby affecting the well-being of the caregiver. We aimed to investigate the effect of spousal mental illness on hospital visits and medical spending among patients with gastrointestinal (GI) cancer.

METHODS

Patients who underwent GI cancer surgery between 2013 and 2020 were identified from the IBM Marketscan database. Multivariable regression analysis was used to examine the association between spousal mental illness and healthcare utilization.

RESULTS

A total of 6,035 patients underwent GI surgery for a malignant indication. Median age was 54 years (IQR: 49-59), most patients were male (n = 3592, 59.5%), and had a CCI score of ≤ 2 (n = 5512, 91.3%). Of note, in the 1 year follow-up period, 19.4% (anxiety: n = 509, 8.4%; depression: n = 301, 5.0%; both anxiety and depression: n = 273, 4.5%; severe mental illness: n = 86, 1.4%) of spouses developed a mental illness. On multivariable analysis, after controlling for competing factors, spousal mental illness remained independently associated with increased odds of emergency department visits (OR 1.20, 95% CI 1.05-1.38) and becoming a super healthcare utilizer (OR 1.37, 95% CI 1.04-1.79), as well as 12.1% (95% CI 10.6-15.3) higher medical spending.

CONCLUSION

Among patients with GI cancer spousal mental illness is associated with higher rates of outpatient visits, emergency department visits, and expenditures during the 1-year postoperative period. These findings underscore the importance of caregiving resources and counseling in alleviating caregiver burden, thereby reducing the overall burden on the healthcare system.

Home-based physical symptom management for family caregivers: systematic review and meta-analysis

BACKGROUND

Patients with life-limiting conditions are often cared for at home by family, typically without adequate training to carry out the challenging tasks performed. This systematic review assessed the efficacy of interventions designed to help family caregivers manage pain and other symptoms in adults and children with life-limiting conditions at home.

METHODS

A systematic search was performed on seven databases. A narrative synthesis was conducted, along with a meta-analysis comparing outcomes in those who received an intervention to those who did not, or to preintervention scores.

RESULTS

84 eligible studies were identified. Significant improvements in pain and fatigue in patients with cancer were found compared with patients in the control group and baseline. Caregivers of patients with cancer receiving an intervention, compared with the control group caregivers, showed significant improvements in self-efficacy and active coping and lower avoidant coping. This group also showed significant improvements in burden, self-efficacy, anxiety and depression, and decreases in avoidant coping pre- to post intervention. Patients with dementia whose caregivers received an intervention showed significantly reduced pain intensity and improvements in quality of life pre- to post intervention. Caregivers of patients with dementia showed significantly reduced distress pre- to post intervention. No beneficial effects were found for caregivers of patients with Parkinson's disease or heart failure, although only limited analyses could be performed.

CONCLUSIONS

Interventions targeting family caregivers can improve both patient symptoms and caregiver outcomes, as demonstrated in cancer and dementia care. Future mixed-methods research should collect data from caregiver and patient dyads, identifying key intervention components. There is also need for more studies on caregivers of paediatric patients.

Assessing caregiver burden: the role of assistive devices and identification of assistive device needs

PURPOSE

There is insufficient information on whether the use of assistive devices is associated with a lower burden on caregivers of individuals with disabilities. This study was conducted (1) to examine how care recipient-level factors, caregiver-level factors, and the use of assistive devices were associated with caregiver burden, and (2) to investigate the assistive device needs of caregivers.

MATERIALS AND METHODS

This cross-sectional descriptive study used surveys. The participants were caregivers of people with disabilities living in Korea (n = 499). The independent variables were care recipient-level factors, caregiver-level factors, and utilization of assistive devices. The outcome variable, caregiver burden, was measured using the Korean Caregiver Burden Scale. For the data analysis, multivariate logistic regression models were built on the caregiver burden using variables that showed statistical significance in the univariate analysis.

RESULTS

Model 1 included care recipient-level factors. Model 2 included caregiver-level factors in addition to care-recipient factors to examine caregiver factors associated with burden. Model 3 included the utilization of care devices, in addition to the variables used in Model 2, to investigate whether the use of care devices was associated with a lower burden. Caregivers who were married, were informal caregivers, or experienced greater psychological stress had an increased probability of experiencing caregiver burden. Moreover, not using assistive devices increases the odds of experiencing caregiver burden. The most desirable properties of devices are transfer, mobility, and bathing.

CONCLUSION

As the use of assistive devices is associated with caregiver burden, such care devices should be developed and provided to caregivers based on their individual needs.

Informal caregiving and mental health: results from the Belgian health interview survey 2013 and 2018

BACKGROUND

Due to a globally ageing population, the demand for informal caregivers is increasing. This study investigates the socio-demographic profile of informal caregivers in Belgium and assesses the relationship between informal care (intensity and care recipients) and mental health, considering potential moderators like education, age, and gender.

METHODS

Using population-based data from the 2013 and 2018 waves of the Belgian Health Interview Survey (N = 14,661), we conducted multivariate (multinomial/ordinal) logistic and linear regression analyses to examine the socio-demographic profile of informal caregivers and their psychological distress, measured through the General Health Questionnaire (GHQ-12).

RESULTS

The prevalence of informal caregiving increased from 10.0% in 2013 to 13.0% in 2018. Informal caregivers were predominantly female, middle-aged, and often had no paid job. High-intensity caregivers (over 20 h/week) experienced significantly higher psychological distress compared to non-caregivers, whereas lower-intensity caregivers did not. Additionally, while gender, age, and education were significant predictors of who becomes a caregiver, they did not moderate the relationship between caregiving and mental health.

CONCLUSIONS

Our findings suggest that the stress of caregiving is more directly related to the nature and intensity of the caregiving tasks themselves rather than the demographic characteristics of the caregivers. Interventions aimed at reducing the adverse effects of caregiving might need to be universally applicable to all caregivers, focusing on reducing the intrinsic burdens of caregiving tasks rather than targeting demographic subgroups.

Public Interest in Research on Aging: Analysis of Altmetric Attention Scores Over 5 Years

This study pinpoints the areas in gerontological research that have commanded the most public attention as scored by Altmetric. We collected 12,740 outputs published in gerontological journals over 5 years from 2017 to 2022. Next, we identified the top 5% of outputs with the highest Altmetric Attention Scores. After removing duplicate publications and those without an abstract, 588 outputs remained. Our content analysis of the abstracts was conducted deductively and inductively. Theme 1 (50%; N = 293) revolved around "Health and Well-Being" (Theme 1). Theme 2 (28%; N = 164) was about "Health Services, Interventions and Innovations." Theme 3 was about "Informal and Long-Term Care" (13%; N = 80). Theme 4 focused on "Structural Inequalities" affecting older adults (9%; N = 51). Gerontologists should strengthen collaboration with other stakeholders to better engage the public across different age-related issues. These partnerships will enable the creation of initiatives that better serve the needs of aging populations.

Caregiving Appraisals and Emotional Valence: Moderating Effects of Activity Participation

The present study examines the extent to which a two-factor model of affect explains how caregiving appraisals experienced by caregivers influence their own well-being. We used data from three waves of Nation Study of Caregiving (NSOC) to conduct latent growth curve models with the time-varying predictors to investigate the effect of between-person (BP) and within-person (WP) caregiving appraisals on positive and negative affect. Furthermore, we simultaneously modeled WP differences in activity participation and affective experience with multilevel modeling. Then, we tested the moderating effect of activity participation in the association between WP caregiving appraisals and emotional valence. We found that BP and WP caregiving negative appraisal also contribute to caregiver positive affect similar to that of negative affect. Time-varying effects of negative appraisals and emotional valence are consistent with the two-factor model. Future longitudinal investigations could target WP and BP activity participation to alleviate caregiving cognitive appraisal among caregivers.

Health and economic impact of caregiving on informal caregivers of people with chronic diseases in sub-Saharan Africa: A systematic review

With a disproportionate burden of chronic diseases and severe shortage of health workers in sub-Saharan Africa, the region implicitly relies on informal caregivers (ICGs) to support the patients both within and outside the health facilities. The aim of this review is to systematically summarise evidence on the health and economic impact of caregiving on informal caregivers of patients with chronic diseases in sub-Saharan Africa. Medline (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), Global Health, and Web of Science databases were systematically searched to identify original articles that considered the economic and/or health impacts of caregiving in sub-Saharan Africa. The results from the included studies were synthesised narratively. After screening 4,951 records, 47 studies were included for synthesis. The articles were from all sub-regions of sub-Saharan Africa with more than half (25/47) of the studies focussing on caregivers for patients with cancer. Although the primary motivation for becoming caregivers was love and responsibility, the caring responsibilities described in twenty studies, had profound effects on the caregiver's lives. Healthwise, the informal caregivers experienced changes in their physical and mental health like developing musculoskeletal problems and depression. Economically, caregiving was expensive, and financially draining. The opportunity cost of caregiving included loss of jobs, loss of income, foregoing planned important activities and missed education opportunities. Informal caregivers reported a range of mainly negative health and economic effects of the work they do. Health care systems should consider how to better support caregivers in terms of their own physical and mental wellbeing. Also, governments should develop strategies to financially support informal caregivers.

Education Programs for Informal Caregivers of Noncancer Patients in Home-Based Palliative Care: A Scoping Review

The literature available on the topic of education programs for noncancer patients' informal caregivers (ICs) is heterogeneous and fragmented in the setting of palliative care (PC). We conducted a scoping review (ScR) to map the literature on educational programs for ICs in home-based PC, considering the available reviews, qualitative studies, observational studies, studies of validation of measurement tools, uncontrolled trials, nonrandomized controlled trials, and feasibility studies. This ScR included 21 eligible records by searching PubMed, Web of Science, Embase, Scopus, and CINAHL databases. The most common types of study designs were literature review (28%), qualitative research (24%), and experimental or quasiexperimental research (19%). A total of 57% of educational interventions or programs were mainly supplied by nurses, alone or with other health professionals; specifically, nurses mostly led supportive intervention (n = 2; 25%), education programs (n = 2; 25%), and app development. Different factors at the microsystem, macrosystem, mesosystem, and exosystem levels might help or hinder the implementation of IC education. Although ICs might more easily access online programs, accessibility and digital exclusion might represent significant barriers. Supportive interventions might positively affect family ICs' preparedness, competence, burden, care outcomes, and experiences related to their role; moreover, it might increase ICs' self-rated competence in all key areas: physical, emotional, psychological, social, informational, and spiritual. ICs can improve their knowledge, confidence, and attitudes toward PC. The literature summary might render the assistance more accessible to ICs to improve the quality of caregiving and nursing care linked to patient and caregiver outcomes. However, robust studies (e.g., randomized controlled trials) are still required to identify and establish the efficacy of each described intervention and, therefore, offer tailored approaches considering the diverse diseases and social and cultural characteristics of patients and ICs.

Efficacy of Health Literacy Interventions for Caregivers of Individuals with Neurodevelopmental and Chronic Conditions: A Rapid Review

BACKGROUND/OBJECTIVES

Caregivers of individuals with neurodevelopmental and chronic health conditions require health literacy (HL) skills for the long-term management of these conditions. The aim of this rapid review was to investigate the efficacy of HL interventions for these caregivers.

METHODS

Five databases (Cochrane Central, PubMed, Embase, CINAHL, and PsycINFO) were searched. Studies were eligible for inclusion if they reported the efficacy of any intervention aimed at improving the HL of caregivers of individuals with a neurodevelopmental disorder or chronic condition and assessed caregiver HL. All original intervention study designs were eligible, as were systematic reviews. Studies had to be published in English since 2000; grey literature was excluded. The review was registered before commencement with PROSPERO (CRD42023471833).

RESULTS

There were 3389 unique records, of which 28 papers (reporting 26 studies) were included. In these studies, 2232 caregivers received interventions through a wide range of media (online, group, written materials, one-to-one, video, phone, and text messages). Research designs were classified as Levels I (n = 8), II (n = 5), III (n = 2), and IV (n = 11), and the quality of evidence ranged from high to very low. Half (n = 7) of the trials with moderate to high evidence levels reported significant between-group differences in caregiver HL outcomes and/or individuals' health-related outcomes. Effective interventions occurred across a wide range of conditions, ages, and carer education levels and using a diversity of intervention media.

CONCLUSIONS

HL interventions for caregivers of individuals with neurodevelopmental and chronic conditions can improve health-related outcomes and caregivers' HL. Longer and more intensive HL programs may be more likely to be effective, but attention must be paid to participant retention.

Designing a multicomponent intervention to support caregivers of persons with dementia in primary care in Spain: a qualitative study of family and professional carers

OBJECTIVE

The purpose of this study was to explore experiences of family and professional caregivers of persons with dementia in order to design a tailored community-based support programme.

DESIGN

A two-stage study was deployed. First, qualitative research draws on three focus groups. Two of these comprised family caregivers and the third was made up of care provision professionals. Thematic content analysis was conducted by interpretative description for applied practice. Second, an experience-based codesign methodology was applied to design a tailored support programme in accordance with carers' demands and contextual realities.

SETTING AND STUDY PERIOD

Rural region in Catalonia, at northeast of Spain. March-June 2019.

PARTICIPANTS

We interviewed 12 family caregivers and 8 primary care providers.

RESULTS

10 main themes were identified: caregivers' feelings, repercussions of caregiving in caregivers' lives, education about dementia and caring skills, education about time management and self-care, caregivers' needs to receive more information and training, improved patients' follow-up and social assistance and more psychologic support. Finally, three themes related to caregivers' demands: social services resources, multidisciplinary approach programmes and support from other caregivers. From these results, a multicomponent, professionally led community-based intervention was designed. The main components were the following: education and caring skills, professional psychological support, and social and community resources.

CONCLUSION

This study allowed the design of a multicomponent support intervention for family caregivers of persons with dementia aimed at reducing their burden and improving their quality of life in ways consistent with their actual needs and the available local resources.

Association between adherence to behavioral intervention and capability well-being among parents of autistic children: a cross-sectional study from China

BACKGROUND

High adherence to behavioral interventions among parents of autistic children contribute to improvement in children's behaviors and parental outcomes. However, most of previous studies focused on the effects of intervention adherence on health-related well-being among parents, which is inadequate to capture the multi-dimensional parental burden of caring for autistic children. The aim of this study is to assess the association between parents' adherence to behavioral intervention and their capability well-being.

METHODS

A cross-sectional study was conducted among caregivers of autistic children aged 1-17 years with a confirmed diagnosis in China. A total of 213 parents of autistic children who were currently receiving behavioral intervention were considered in this study. Parental adherence to behavioral intervention was evaluated by the 5-item General Adherence subscale of the Medical Outcome Study. Capability well-being was assessed using the Investigating Choice Experiments Capability Measures for Adults (ICECAP-A), including the domains of stability, attachment, autonomy, achievement, and enjoyment. The index scores for each domain were computed based on the preference-based value set in the United Kingdom, ranging from 0 to 1. Multivariate linear regression analyses were conducted to assess the relationship between intervention adherence and parental well-being. Intervention adherence as well as the variables with p < 0.1 in the univariate analyses were included in multivariate linear regression analyses.

RESULTS

The mean overall score of ICECAP-A was 0.681 (0.205). In the univariate analyses, intervention adherence was positively associated with stability, autonomy, achievement, and enjoyment (p < 0.05), while the relationship between intervention adherence and attachment was not significant (p = 0.07). After controlling for the confounders in the multivariate linear regression analyses, intervention adherence was positively associated with achievement (β = 0.0004) and enjoyment (β = 0.0004).

CONCLUSIONS

The overall capability well-being among parents of autistic children was worse than that of the general population and caregivers of adult patients with chronic diseases. Adherence to behavioral interventions was positively associated with parental well-being in terms of achievement and enjoyment. Health professionals should involve parents in behavioral interventions and encourage them to implement therapeutic strategies on a routine basis. Customized interventions are warranted to improve capability well-being targeting at vulnerable groups.

Dyadic relationships between informal caregivers and older adults with chronic heart failure: a systematic review and meta-synthesis

AIMS

To synthesize the qualitative evidence on dyadic relationships between informal caregivers and older adults with chronic heart failure (HF).

METHODS AND RESULTS

A systematic review and meta-synthesis were conducted. Eight databases were searched for English peer-reviewed studies and grey literature published from inception to 27 February 2024. Qualitative and mixed-method studies involving older adults ≥55 years old with chronic HF and discussing patient-caregiver relationships in community settings were included. Data were synthesized using Sandelowski and Barroso's two-step framework. A meta-summary was developed using thematic analysis, and findings were synthesized using the Theory of Dyadic Illness Management. Twenty-four studies from 2008 to 2024 were included (n = 580 participants). The meta-summary consisted of four themes and nine subthemes: (i) Characteristics of dyad relationships, (ii) How both parts of the dyad care for each other, (iii) Chronic HF and dyad relationships, and (iv) Knowledge of managing chronic HF. These were reorganized into the meta-synthesis: dyadic appraisal, dyadic management behaviours, dyadic health, contextual factors affecting dyadic relationships and management behaviours, and illness management as a dyadic phenomenon.

CONCLUSION

Investigating relationship dynamics and their impact on dyads and chronic HF self-care is vital. Where possible, healthcare providers should prioritize dyadic care when caregivers are involved and deliver individualized care to improve patient and caregiver outcomes. Assessing and optimizing dyadic relations, addressing individual perceptions and needs as part of clinical care, and before implementing self-care interventions in research may help ensure that self-care is appropriately tailored and would not be hindered by relationship conflicts.

"This takes a toll on me too"-a qualitative interview study on experiences of informal caregivers to patients who have had aneurysmal subarachnoid haemorrhage

PURPOSE

To describe life as an informal caregiver to someone affected by an aneurysmal subarachnoid haemorrhage (aSAH) in the first year after the event.

METHODS

A qualitative descriptive study in which informal caregivers (n = 16) to patients treated for aSAH were interviewed one year after the event. An interview guide was used and an inductive, conventional content analysis was applied.

RESULTS

Expressions of missing the previous person were evident, as she/he had changed after the aSAH. The informants described an impact on their social life, with limited time for social activities, social interactions, and hobbies. Their working lives were also affected. Findings further indicated that professional support for informal caregivers, if offered, was fragmented, person-dependent, or offered at the wrong time.

CONCLUSION

A journey with frustration and hope, impacting on relationships, social life, and working life, was evident. As few studies have focused on the perspective of informal caregivers to someone affected by aSAH, the findings are important both for research purposes and the healthcare sector. The results could form the basis for a larger exploration of support needs and how both patients and informal caregivers would like to help design and develop such support.

Caregiving Time of Unpaid Family Caregivers Assisting Older Adults With Hearing Difficulty

Objectives: We aimed to investigate the association of older adults' hearing difficulty status with caregiving time. Methods: We used data from two linked surveys of Medicare beneficiaries and family caregivers. Hearing difficulty was defined by hearing aid use and hearing capacity in functional settings. Weighted multivariable linear regression examined the association between hearing difficulty and caregiving time. Stratified analyses were conducted to investigate the moderation effects of caregiving networks and care recipient's dementia status. Results: Among 3003 caregivers, those who assisted older adults with hearing difficulty were observed to spend greater time providing care (β = 1.18, 95% Confidence Interval [CI]: 1.04, 1.32). Stronger associations in magnitude were observed among caregivers without caregiving networks (β = 1.35, 95% CI: 1.13, 1.56) and assisting older adults without dementia (β = 1.22; 95% CI = 1.06, 1.37). Discussion: Hearing difficulty may contribute to greater caregiving time and remains a potential target for caregiver support programs.

Defining Informal Caregiving and Caregivers for Persons Living With Dementia

PURPOSE

To present an overview of current definitions of informal caregiving and informal caregivers for persons living with dementia (PLWD). We suggest definitional criteria of informal caregiving for dementia caregiving research that incorporate current dementia caregiving policy and programs.

METHOD

A multi-pronged review and analysis was performed of the scientific literature from 2014 to 2024 and online documents from professional, public advocacy, and government organizations for definitions of informal caregiving and applications to informal caregiving of PLWD.

RESULTS

Definitional inconsistencies in informal caregiving center primarily on parameters around compensation ("unpaid") and relationships that are not in keeping with state, federal, and long-term care insurance programs that provide financial assistance, compensation, or stipends for caregiving. These inconsistencies extend to public policy and advocacy websites as well as peer-reviewed dementia and family caregiving literature.

CONCLUSION

In general, contemporary applications of the term "informal caregiver" for PLWD include relatives and non-relatives (kin/nonkin) who provide a broad array of assistance to PLWD. Informal care activities may be provided in residence with or near PLWD or at a distance. Definitions and inclusion criteria for informal caregiver should specify relative or unpaid non-relative, having some prior relationship or social ties to the PLWD, and not receiving compensation for care for the PLWD from a caregiving institution. [Journal of Gerontological Nursing, 50(12), 41-45.].

Caregiving in Asia: Priority areas for research, policy, and practice to support family caregivers

Population aging presents a growing societal challenge and imposes a heavy burden on the healthcare system in many Asian countries. Given the limited availability of formal long-term care (LTC) facilities and personnel, family caregivers play a vital role in providing care for the increasing population of older adults. While awareness of the challenges faced by caregivers is rising, discussions often remain within academic circles, resulting in the lived experiences, well-being, and needs of family caregivers being frequently overlooked. In this review, we identify four key priority areas to advance research, practice, and policy related to family caregivers in Asia: (1) Emphasizing family caregivers as sociocultural navigators in the healthcare system; (2) addressing the mental and physical health needs of family caregivers; (3) recognizing the diverse caregiving experiences across different cultural backgrounds, socioeconomic status, and countries of residence; and (4) strengthening policy support for family caregivers. Our review also identifies deficiencies in institutional LTC and underscores the importance of providing training and empowerment to caregivers. Policymakers, practitioners, and researchers interested in supporting family caregivers should prioritize these key areas to tackle the challenge of population aging in Asian countries. Cross-country knowledge exchange and capacity development are crucial for better serving both the aging population and their caregivers.

Engagement in Physical Activity and Quality of Life Among Informal Caregivers of Older Adults

OBJECTIVES

This study examined (1) the association of caregiver engagement in physical activity (PA) with their quality of life (QoL) and (2) the moderating effect of caregiver engagement in PA on the relationship between several caregiving stressors and their QoL, among informal caregivers of older adults.

METHODS

Multivariable regression was applied to data from 278 adult caregivers, aged 23-90 years, in Singapore.

RESULTS

Engagement in PA by caregivers was positively associated with psychological, social relationships, and environment domains of their QoL. Caregiver engagement in PA also mitigated the negative association between care-recipient mood impairment and QoL of caregivers in the physical health and social relationships domains.

DISCUSSION

QoL of caregivers may be improved or protected by their regular engagement in PA, especially when their care-recipients have mood impairment. Policymakers and practitioners should encourage caregivers to engage in PA and provide them with the necessary support to do so.

The Healthy Caregiver? A Positive Impact of Informal Caregiving Status on Cognitive Functions Over Time From the Midlife in the United States Study

OBJECTIVES

The current study examined whether informal caregivers performed worse, better, or similar to non-caregivers on cognitive tests of executive functioning and episodic memory over 10 years. Methods: Data were from waves 2 (2003-04) and 3 (2013-14) of the Midlife in the United States (MIDUS) study (N = 2086). Multiple linear regression models examined whether caregiving at both waves 2 and 3 predicted better cognitive functioning at wave 3, than caregiving at only one time point or no caregiving (reference) while controlling for baseline covariates (i.e., sociodemographic, health, and functional status).

RESULTS

After controlling for covariates, caregiving at both waves was independently associated with better performance in episodic memory (b = .24, SE = .10, p = .013) but not executive function (b = -.06, SE = .05, p = .246). Discussion:The findings partially supported both healthy caregiver and stress process models, indicating caregiving may be associated with better episodic memory but not executive functioning over time among the middle-aged and older adults.

Caregiving burden, depression, and anxiety in informal caregivers of people with mental illness in China: a cross-sectional survey

BACKGROUND

Caregiving for people with mental illness (PwMI) could be burdensome, especially for informal caregivers. However, there is a scarcity of research investigating caregiving burden among informal caregivers of PwMI in China at the national level. To fill this gap, this study examined the prevalence of caregiving burden, depression, and anxiety, as well as their associated factors, among a cross-sectional sample of informal caregivers of PwMI in China.

METHODS

Data were collected via an online survey between June and November 2023. Caregiving burden, depression, and anxiety were measured by the Zarit Burden Interview, the Patient Health Questionnaire, and the Generalized Anxiety Disorder Scale. Information on caregivers' sociodemographic, care recipients' sociodemographic and disease-related, and caregiving-related characteristics was also collected. Hierarchical regression analyses were performed to identify associated factors of caregiving burden, depression, and anxiety.

RESULTS

A total of 1,224 informal caregivers of PwMI in China were included in the final analysis. 72.1% of the participants had high caregiving burden, 53.5% had moderate to severe depression, and 43.1% had moderate to severe anxiety. Caregiving burden, depression, and anxiety were inter-correlated with each other but exhibited different profiles of associated factors. The most important factors associated with all the three outcomes were disease-related characteristics, particularly care recipients' symptom stability, medication compliance, and insight. Informal caregivers of males with mental illness had higher levels of caregiving burden, depression, and anxiety than those of females. There was a lack of differentiation in caregiving burden, depression, and anxiety based on care recipients' diagnosis. Formal or common-law marriage was a protective factor for caregiver depression and anxiety but not for caregiving burden.

CONCLUSION

Informal caregivers of PwMI in China experienced a high level of caregiving burden, depression, and anxiety. Urgent actions are needed to relieve caregiving burden, depression, and anxiety among informal caregivers of PwMI in China.