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Duangjina T, Hershberger PE, Gruss V, Fritschi C. Resilience in family caregivers of Asian older people with dementia: An integrative review. J Adv Nurs 2024. [PMID: 38863175 DOI: 10.1111/jan.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
AIM To identify factors associated with resilience in family caregivers of Asian older people with dementia based on Luthar and Cicchetti's definition of resilience. DESIGN Integrative review of resilience in family caregivers of Asian older people with dementia reported by studies with quantitative and qualitative research designs. DATA SOURCES Databases used for the literature search included CINAHL, PubMed, EMBASE, PsycINFO and Google Scholar. REVIEW METHODS A total of 565 potentially relevant studies published between January 1985 and March 2024 were screened, and 27 articles met the inclusion criteria. RESULTS Family caregivers were most commonly adult children of care recipients, female and providing care in their home. Two themes emerged from the review: factors associated with adversity (dementia severity, caregiver role strain, stigma, family stress, female gender, low income and low education) and factors associated with positive adaptational outcomes (positive aspect of caregiving, social support and religiosity/spirituality). CONCLUSION In our review of Asian research, four new factors-caregiver role strain, stigma, family stress and positive aspects of caregiving-emerged alongside those previously identified in Western studies. A paradigm shift was observed from a focus on factors associated with adversity to factors associated with positive adaptational outcomes, particularly after the issuance of the WHO's 2017 global action plan for dementia. However, a gap remains between WHO policy recommendations and actual research, with studies often neglecting to address gender and socioeconomic factors. IMPACT The review findings will broaden healthcare providers' understanding of resilience in dementia caregivers and use them to develop comprehensive programmes aimed at reducing factors associated with adversity and enhancing those associated with positive adaptational outcomes. This approach can be customized to incorporate Asian cultural values, empowering caregivers to navigate challenges more effectively. NO PATIENT OR PUBLIC CONTRIBUTION This paper is an integrative review and does not include patient or public contributions.
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Affiliation(s)
- Thitinan Duangjina
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- Department of Biobehavioral Nursing, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia E Hershberger
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Valerie Gruss
- Department of Biobehavioral Nursing, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Cynthia Fritschi
- Department of Biobehavioral Nursing, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Matta-Singh TD, Sharma S, Ali T, Piechota A, Abboud A, Fried T, Monin JK, Mroz EL. Former dementia caregivers' high and low point narratives: what is remembered, and how is it shared? Aging Ment Health 2024; 28:427-435. [PMID: 37712688 PMCID: PMC10922763 DOI: 10.1080/13607863.2023.2256252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES To characterize core themes conveyed by caregivers when sharing narratives of high and low caregiving points and to describe how caregivers structured these narratives. METHODS Using consensual qualitative research and thematic analysis, high and low point narratives from 32 former caregivers of persons living with dementia were examined. RESULTS High point narrative themes involved strengthening relationships with care partners, fulfillment derived from care, lighthearted moments, and fostering the care partners' joy and dignity. Low point narratives involved family conflict and lack of support, personal deficiencies, loss of the caregivers' 'pre-caregiving' life, health system failures, and alienation from their care partner. Across high and low points, caregivers' narratives were structured by three types of narrative elaborations; details unnecessary for factual recall but which enriched narrative sharing. CONCLUSION Themes across high and low point narratives encompassed relational issues, how caregiving shaped the caregiver's self-efficacy, and factors that made navigating caregiving easier or more difficult. Both high point and low point narration often involved describing positive aspects of caregiving (PAC). Narrative elaborations may be used by former caregivers to engage in deeper evaluation of their caregiving experiences. We consider how psychotherapeutic techniques can help former caregivers reframe maladaptive narratives, supporting their mental health.
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Affiliation(s)
| | - Shubam Sharma
- Department of Psychological Science, Kennesaw State University, Kennesaw, GA, USA
| | - Talha Ali
- Department of Community Health, Tufts University, Boston, MA, USA
| | - Amanda Piechota
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Anissa Abboud
- Department of Health Policy, Yale School of Public Health, New Haven, CT, USA
| | - Terri Fried
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joan K. Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Emily L. Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Duangjina T, Fink AM, Gruss V. Resilience in Family Caregivers of Asian Older Adults With Dementia: A Concept Analysis. ANS Adv Nurs Sci 2023; 46:E145-E160. [PMID: 36728751 DOI: 10.1097/ans.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Asian family caregivers of older adults with dementia have stressful caregiving situations over long periods; they must become resilient to recover from adversity. A conceptual definition of resilience specific to Asian family caregivers is important for understanding their caregiving phenomena and the relationships with mental health and psychological well-being. The purpose of this concept analysis was to define resilience in family caregivers of Asian older adults with dementia using Walker and Avant's method. The findings of the analysis will guide future research about the modifiable factors that will prevent negative health outcomes in this population of caregivers.
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Affiliation(s)
- Thitinan Duangjina
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand (Ms Duangjina); and Biobehavioral Nursing Science Department, College of Nursing, University of Illinois Chicago, Chicago (Ms Duangjina and Drs Fink and Gruss)
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Peker A, Yalçın RÜ. Resilience levels of Turkish adolescents cyber-victims in social networking sites: The mediation roles of cyberbullying and active coping. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lou VW, Cheng CYM, Yu DSF, Wong DFK, Lai DWL, Chong AML, Chen S, Chou KL. Meaning Making as a Lifebuoy in Dementia Caregiving: Predicting Depression from a Generation Perspective Using a Fuzzy-Set Qualitative Comparative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15711. [PMID: 36497785 PMCID: PMC9736359 DOI: 10.3390/ijerph192315711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Depressive symptomatology is associated with caregiver burden and poor health outcomes among dementia caregivers. Scholars called for a paradigm shift to focus on positive aspects of caregiving, in particular, meaning making during the caregiving journey. This study draws on the meaning making model and a generation perspective to predict depression among dementia caregivers from two generations, including Baby Boomers who were born between 1946 and 1964 and Generation X who were born between 1965 and 1980, using a configuration approach. Data was collected in a two-wave longitudinal design, from December 2019 to March 2021 in Hong Kong. A fuzzy-set qualitative comparative analysis resulted in six configurations with an overall solution consistency and overall solution coverage of 0.867 and 0.488, respectively. These configurations consist of a different combination of conditions that predict high depressive symptomatology among dementia caregivers in two generations. Specifically, generation is related to five out of six configurations. This study is the first to predict depression among dementia caregivers using a meaning making model from a generation perspective. It advances the understanding of factors contributing to high depressive symptomatology among dementia caregivers from two generations, thus contributing to the future development of generation-responsive assessments, interventions, and policies.
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Affiliation(s)
- Vivian Weiqun Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Clio Yuen Man Cheng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Doris Sau Fung Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Daniel Fu Keung Wong
- Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, China
| | - Daniel W. L. Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, China
| | - Alice Ming Lin Chong
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong, China
| | - Shuangzhou Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
- Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong Island, Hong Kong, China
| | - Kee Lee Chou
- Department of Asian and Policy Studies, The Education University of Hong Kong, Tai Po, New Territories, Hong Kong, China
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Caregiver Burden in Distance Caregivers of Patients with Cancer. Curr Oncol 2022; 29:8967-8974. [PMID: 36421357 PMCID: PMC9689057 DOI: 10.3390/curroncol29110704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022] Open
Abstract
Distance caregivers (DCGs), those who live more than an hour away from the care recipient, often play a significant role in patients' care. While much is known about the experience and outcomes of local family caregivers of cancer patients, little is known about the experience and outcomes of distance caregiving upon DCGs. The purpose of this study was to identify the relationships among stressors (patient cancer stage, anxiety, and depression), mediators (DCG emotional support and self-efficacy), and burden in DCGs' of patients with cancer. This study was a descriptive cross-sectional study and involved a secondary data analysis from a randomized clinical trial. The study sample consisted of 314 cancer patient-DCG dyads. The results of this study were: (1) 26.1% of DCGs reported elevated levels of burden; (2) significant negative relationships were found between mediators (DCG emotional support and self-efficacy) and DCG burden; and (3) significant positive relationships were found between patient anxiety, depression, and DCG burden. The prevalence of burden in DCGs, and its related factors, were similar to those of local caregivers of cancer patients, which suggests that interventions to reduce burden in local caregivers could be effective for DCGs as well.
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Mahomed A, Pretorius C. Understanding the lived experiences of family caregivers of individuals with dementia in Soweto, a South African Township. DEMENTIA 2022; 21:2264-2287. [DOI: 10.1177/14713012221118441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study was undertaken to understand South African family caregivers’ lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience.
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Gutierrez-Baena B, Romero-Grimaldi C. Predictive model for the preparedness level of the family caregiver. Int J Nurs Pract 2022; 28:e13057. [PMID: 35388583 PMCID: PMC9285821 DOI: 10.1111/ijn.13057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/14/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
Background Many caregivers are insufficiently prepared, and little is known about measures that can be employed to enhance their preparedness. Aim The aim of this study was to explore the factors associated with caregiver preparedness and establish a predictive model including the relationship between preparedness, burden, resilience and anxiety. Design A cross‐sectional design was used. Methods The sample included 172 family caregivers who were selected from one private hospital and daytime nursing centres. Caregivers were recruited from 2018 to 2019; they completed assessments for caregiver preparedness, anxiety, resilience and burden. A multiple linear regression analysis was performed to identify the factors associated with preparedness. Results Preparedness was significantly associated with high levels of resilience and a low level of burden, while it was not associated with anxiety. Caregivers' gender, experience and cohabitation status were the main predictors. Resilience is an explanatory factor for caregiver preparedness in the predictive model. Conclusion The demographic variables related to preparedness can be used to guide efforts to meet the needs of vulnerable caregivers. A caregiver's preparedness depends on their level of burden and resilience. Nursing interventions focused on these aspects could make the caregiver's role easier and improve the quality of care provided. What is already known about this topic?
Many caregivers are inadequately prepared for this role, and ensuring adequate preparedness is important for family caregivers. Preparedness and factors predictive of this in Spanish family caregivers have not been well‐documented. Resilience, burden and anxiety affect caregivers, but the degree to which they influence caregivers' preparation levels is unknown.
What is the contribution of this paper?
Specific factors influence the preparedness of family caregivers. Men and caregivers who do not cohabit in the same household with the care‐dependent person may present greater deficits in preparedness. Moreover, poor health and lack of experience in caring can result in inadequate caregiving performance. Readiness, resilience and burden are significantly related, and the best predictor of family caregivers' preparedness is resilience. Resilience leads to greater preparedness in caregivers, and better‐prepared caregivers experience a lighter burden.
What are the implications of this paper?
Knowing the factors associated with preparedness in advance will allow health‐care professionals to prevent deficits in vulnerable family caregivers. Resilience is a decisive factor which prevents negative consequences such as low preparedness. A resilient coping style can diminish the burden and promote successful adaptation in caregivers.
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Affiliation(s)
- Belen Gutierrez-Baena
- Nursing Faculty Salus Infirmorum, University of Cadiz, Cadiz, Spain.,Hospital Viamed Bahia de Cádiz, Chiclana de la Frontera, Cadiz, Spain
| | - Carmen Romero-Grimaldi
- Nursing Faculty Salus Infirmorum, University of Cadiz, Cadiz, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Chen S, Wang T, Bao Z, Lou V. A Path Analysis of the Effect of Neighborhood Built Environment on Public Health of Older Adults: A Hong Kong Study. Front Public Health 2022; 10:861836. [PMID: 35359794 PMCID: PMC8964032 DOI: 10.3389/fpubh.2022.861836] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Health deterioration among frail older adults is a public health concern. Among the multi-dimensional factors, the neighborhood built environment is crucial for one's health. Although the relationship between the built environment and health in the general population has been thoroughly investigated, it has been ignored in the case of frail older adults, who may have difficulties in their daily basic living skills. A path analysis is constructed to model the proposed theoretical framework involving the neighborhood built environment and health among frail older adults. This study thus aims to investigate the environmental influences on health, and to validate the theoretical framework proposed for health and social services. Methods This study used secondary data collected in Hong Kong. A sample of 969 older community dwellers aged 60 or above were frail with at least one activity of daily living. Demographic information, neighborhood built environment data, service utilization, and health conditions were collected from these participants and their caregivers. A path analysis was performed to examine the proposed theoretical framework. Results The health condition was of general concern, including frailty and incapacities in daily activities in frail older adults. Besides psychosocial factors, service use, and caregivers' care quality, the built environment had a significant impact on the health of older adults as well. Specifically, more facilities offering services and groceries, a shorter distance to the nearest metro station, and more greenery exposure are associated with a better-expected health condition among frail older adults. Discussion The proposed theoretical framework successfully supplements past negligence on the relationship between the built environment and the health of frail older adults. The findings further imply that policymakers should promote the usability of transit and greenery in neighborhoods and communities. In addition, service utilization should be improved to meet the basic needs of frail older adults in the communities.
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Affiliation(s)
- Shuangzhou Chen
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China.,Sau Po Center on Ageing, The University of Hong Kong, Hong Kong, China
| | - Ting Wang
- Division of Landscape Architecture, Department of Architecture, The University of Hong Kong, Hong Kong, China
| | - Zhikang Bao
- Department of Real Estate and Construction, Faculty of Architecture, The University of Hong Kong, Hong Kong, China
| | - Vivian Lou
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China.,Sau Po Center on Ageing, The University of Hong Kong, Hong Kong, China
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10
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Cheon H, Song JA, Kim J, Jung S. The Competence Scale in Managing Behavioral and Psychological Symptoms of Dementia (CS-MBPSD) for Family Caregivers: Instrument Development and Cross-sectional Validation Study. Int J Nurs Stud 2022; 129:104205. [DOI: 10.1016/j.ijnurstu.2022.104205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
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Zahir A, Staffaroni AM, Wickham RE, Quinn CM, Sapozhnikova A, Seidman J, Chiong W. Caregiver "objective attitude" toward patients with neurodegenerative disease: Consequences for caregiver strain and relationship closeness. Aging Ment Health 2021; 25:1709-1715. [PMID: 32515603 PMCID: PMC7748409 DOI: 10.1080/13607863.2020.1771541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many caregivers of patients with neurodegenerative disease experience physical and psychological strain, which is associated with negative health outcomes. Caregiver strain may be partly attributable to negative emotional responses (e.g.of resentment) to the behavioral, cognitive, and physical changes associated with patients' disease. The philosopher Peter Strawson observed that in dealing with people who have neurological impairments, we often choose to suspend such emotional responses, adopting what he labeled the "objective attitude," though this may come at the expense of our relationships with them. In this study, we assessed the mediating effect of caregivers' adoption of the objective attitude on caregiver strain and relationship closeness in the setting of disease progression. Caregivers of patients with neurodegenerative disorders (n = 215) completed the Clinical Dementia Rating, Relationship-Closeness scale, Caregiver Strain Index, and a novel questionnaire assessing the adoption of the objective attitude. A structural equation model assessing associations among these variables demonstrated good fit (χ2 (88)=164.621, p < 0.001; CFI = 0.929, RMSEA = 0.064.) and showed that adoption of the objective attitude mediated the association between disease progression and relationship closeness (total β= -0.233, 95% CI: -0.351, -0.113; indirect β= -0.483, 95% CI: -0.602, -0.364; direct β = 0.250, 95% CI: 0.117, 0.384), but did not mediate the association between disease progression and caregiver strain (total β = 0.323, 95% CI: 0.234, 0.412; indirect β = 0.089, 95% CI: -0.027, 0.206; direct β = 0.153, 95% CI: -0.043, 0.349). For future work, we propose longitudinal measurements of these constructs to test the directionality of associations and consideration of how models for caregiver support can draw upon interdisciplinary insights.
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Affiliation(s)
- Ali Zahir
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Adam M. Staffaroni
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | | | - Carson M. Quinn
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Anna Sapozhnikova
- Department of Psychiatry, University of California, San Francisco, USA
| | | | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
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Abstract
A substantial number of neurological diseases lead to chronic impairment of activities of daily living (ADL) and physical or mental dependence. In Austria, homecare is provided mostly by female family members. Moreover, mainly female personnel, in the majority from southern and eastern European countries, contributes to care. Dependence and need for care vary between neurological diagnoses and accompanying diseases. Caregiver burden (CB) depends on patient- and caregiver-related and external factors, such as integrity of a family network, spatial resources, and socioeconomic factors. Depending on the neurological diagnosis, disease severity, and behavioral impairment and psychiatric symptoms, caregivers (CG) are at a significant risk of mental and somatic health problems because of limitations in personal needs, occupational and social obligations, financial burden, and restricted family life and leisure. Subjective and objective CB needs to be assessed in time and support should be provided on an individual basis. Recently, COVID-19 has caused additional multifactorial distress to dependent patients and informal and professional CG.
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Affiliation(s)
- Gerhard Ransmayr
- Department of Neurology II, MedCampus III, Kepler University Hospital, Johannes Kepler University, Medical Faculty, Krankenhausstraße 9, 4020, Linz, Austria.
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Liu W, Zhang H, Yuan S, Lyu T. Well-being losses by providing informal care to elderly people: Evidence from 310 caregivers in Shanghai, China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:694-702. [PMID: 33662175 PMCID: PMC8252638 DOI: 10.1111/hsc.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/20/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
A series of policies aimed toward rational resource allocation of long-term care have being actively discussed since the launch of the social long-term care insurance in Shanghai, and it is important to take a societal perspective for informed decision-making. This study aims to explore factors that are associated with well-being of informal caregivers in Shanghai, and to provide empirical evidence of application of an established well-being valuation method to monetise informal caregivers' well-being losses in a developing country. 310 informal caregivers of applicants for social long-term care insurance in Shanghai were interviewed. Univariate and multivariate analyses were conducted to explore the associated factors with life satisfaction of the caregivers. The monetary values of an additional hour of caregiving with and without specification of care tasks were estimated by the well-being valuation method. Life satisfaction was consistently associated with monthly income, health status, and caring hours of the caregivers. The money needed to compensate one additional hour of caring per week was 12.58 CNY (0.3% of the monthly income), and 96.95 CNY (2.0% of the monthly income) for activities of daily living (ADL) tasks. Income, health status, and caregiving are significantly associated with well-being of informal caregivers. Caregivers in relatively poor health condition and/or involved in more ADL tasks should be particularly considered in supporting policies in Shanghai.
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Affiliation(s)
- Wenwei Liu
- School of International and Public AffairsShanghai Jiao Tong UniversityShanghaiChina
- College of Philosophy, Law and Political ScienceShanghai Normal UniversityShanghaiChina
| | - Huimin Zhang
- School of International and Public AffairsShanghai Jiao Tong UniversityShanghaiChina
| | - Suwei Yuan
- China Hospital Development InstituteShanghai Jiao Tong UniversityShanghaiChina
| | - Tongzhou Lyu
- College of Philosophy, Law and Political ScienceShanghai Normal UniversityShanghaiChina
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14
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Chan CY, Cheung G, Martinez-Ruiz A, Chau PYK, Wang K, Yeoh EK, Wong ELY. Caregiving burnout of community-dwelling people with dementia in Hong Kong and New Zealand: a cross-sectional study. BMC Geriatr 2021; 21:261. [PMID: 33879099 PMCID: PMC8059033 DOI: 10.1186/s12877-021-02153-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 03/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Informal caregiving for people with dementia can negatively impact caregivers’ health. In Asia-Pacific regions, growing dementia incidence has made caregiver burnout a pressing public health issue. A cross-sectional study with a representative sample helps to understand how caregivers experience burnout throughout this region. We explored the prevalence and contributing factors of burnout of caregivers of community-dwelling older people with dementia in Hong Kong (HK), China, and New Zealand (NZ) in this study. Methods Analysis of interRAI Home Care Assessment data for care-recipients (aged ≥65 with Alzheimer’s disease/other dementia) who had applied for government-funded community services and their caregivers was conducted. The sample comprised 9976 predominately Chinese in HK and 16,725 predominantly European in NZ from 2013 to 2016. Caregiver burnout rates for HK and NZ were calculated. Logistic regression was used to determine the adjusted odds ratio (AOR) of the significant factors associated with caregiver burnout in both regions. Results Caregiver burnout was present in 15.5 and 13.9% of the sample in HK and NZ respectively. Cross-regional differences in contributing factors to burnout were found. Care-recipients’ ADL dependency, fall history, and cohabitation with primary caregiver were significant contributing factors in NZ, while primary caregiver being child was found to be significant in HK. Some common contributing factors were observed in both regions, including care-recipients having behavioural problem, primary caregiver being spouse, providing activities-of-daily-living (ADL) care, and delivering more than 21 h of care every week. In HK, allied-health services (physiotherapy, occupational therapy and speech therapy) protected caregiver from burnout. Interaction analysis showed that allied-health service attenuates the risk of burnout contributed by care-recipient’s older age (85+), cohabitation with child, ADL dependency, mood problem, and ADL care provision by caregivers. Conclusions This study highlights differences in service delivery models, family structures and cultural values that may explain the cross-regional differences in dementia caregiving experience in NZ and HK. Characteristics of caregiving dyads and their allied-health service utilization are important contributing factors to caregiver burnout. A standardized needs assessment for caregivers could help policymakers and healthcare practitioners to identify caregiving dyads who are at risk of burnout and provide early intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02153-6.
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Affiliation(s)
- Crystal Y Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Adrian Martinez-Ruiz
- Instituto Nacional De Geriatría, Mexico City, Mexico.,Department of Population Health, University of Auckland, Auckland, New Zealand
| | - Patsy Y K Chau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kailu Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza L Y Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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15
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Sardella A, Lenzo V, Alibrandi A, Catalano A, Corica F, Quattropani MC, Basile G. A Clinical Bridge between Family Caregivers and Older Adults: The Contribution of Patients' Frailty and Optimism on Caregiver Burden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073406. [PMID: 33806026 PMCID: PMC8037634 DOI: 10.3390/ijerph18073406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
The association between caregiver burden and the physical frailty of older adults has been the object of previous studies. The contribution of patients’ dispositional optimism on caregiver burden is a poorly investigated topic. The present study aimed at investigating whether older adults’ multidimensional frailty and optimism might contribute to the burden of their family caregivers. The Caregiver Burden Inventory was used to measure the care-related burden of caregivers. The multidimensional frailty status of each patient was evaluated by calculating a frailty index, and the revised Life Orientation Test was used to evaluate patients’ dispositional optimism. The study involved eighty family caregivers (mean age 64.28 ± 8.6) and eighty older patients (mean age 80.45 ± 7.13). Our results showed that higher frailty status and lower levels of optimism among patients were significantly associated with higher levels of overall burden and higher burden related to the restriction of personal time among caregivers. Patients’ frailty was additionally associated with caregivers’ greater feelings of failure, physical stress, role conflicts, and embarrassment. Understanding the close connection between patient-related factors and the burden of caregivers appears to be an actual challenge with significant clinical, social, and public health implications.
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Affiliation(s)
- Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.S.); (M.C.Q.)
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, “Dante Alighieri” University for Foreigners of Reggio Calabria, 89125 Reggio Calabria, Italy;
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Science, Department of Economics, University of Messina, 98123 Messina, Italy;
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, School and Unit of Geriatrics, University of Messina, 98125 Messina, Italy; (A.C.); (F.C.)
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, School and Unit of Geriatrics, University of Messina, 98125 Messina, Italy; (A.C.); (F.C.)
| | - Maria C. Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.S.); (M.C.Q.)
| | - Giorgio Basile
- Department of Clinical and Experimental Medicine, School and Unit of Geriatrics, University of Messina, 98125 Messina, Italy; (A.C.); (F.C.)
- Correspondence:
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16
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Coping strategies, cyberbullying behaviors, and depression among Chinese netizens during the COVID-19 pandemic: a web-based nationwide survey. J Affect Disord 2021; 281:138-144. [PMID: 33321378 PMCID: PMC7725059 DOI: 10.1016/j.jad.2020.12.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/14/2020] [Accepted: 12/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND As a major life stressor now, the COVID-19 pandemic could substantially increase risks of cyberbullying and depression for global people, especially in the context of increased digital interconnectedness and strict social distancing. Though people are adopting different coping strategies, still little is known about their cyberbullying and depression and how the two associated with coping strategies. METHODS A web-based nationwide questionnaire survey was conducted among 5,608 netizens during the peak time of COVID-19 in China. The study collected cross-sectional data on participants' coping strategies, general cyberbullying behaviors, cyberbullying behaviors specifically to residents of Hubei Province where first COVID-19 case was reported, and depression. RESULTS A two-factor structure applied to participants' coping strategies, namely problem-focused coping and emotion-focused coping, and the former was more adopted. There existed gender, age, education, and income differences in the coping strategies. Problem-focused coping was associated with less cyberbullying behaviors while had no correlation with depression; emotion-focused coping was found positively correlated with cyberbullying and depression. The association between emotion-focused coping and depression was mediated by cyberbullying. LIMITATIONS The study used cross-sectional design, and its findings should be cautioned to be generalized to other countries, due to the differences in culture, stage of crisis, and government policies on COVID-19. CONCLUSIONS Problem-focused coping was associated with less cyberbullying, and emotion-focused coping predicted cyberbullying and depression. Cyberbullying mediated the correlation between emotion-focused coping and depression. These findings provide new perspectives for interventions on people's coping strategies towards COVID-19 pandemic.
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17
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Rainero I, Bruni AC, Marra C, Cagnin A, Bonanni L, Cupidi C, Laganà V, Rubino E, Vacca A, Di Lorenzo R, Provero P, Isella V, Vanacore N, Agosta F, Appollonio I, Caffarra P, Bussè C, Sambati R, Quaranta D, Guglielmi V, Logroscino G, Filippi M, Tedeschi G, Ferrarese C. The Impact of COVID-19 Quarantine on Patients With Dementia and Family Caregivers: A Nation-Wide Survey. Front Aging Neurosci 2021; 12:625781. [PMID: 33536898 PMCID: PMC7849158 DOI: 10.3389/fnagi.2020.625781] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Previous studies showed that quarantine for pandemic diseases is associated with several psychological and medical effects. The consequences of quarantine for COVID-19 pandemic in patients with dementia are unknown. We investigated the clinical changes in patients with Alzheimer’s disease and other dementias, and evaluated caregivers’ distress during COVID-19 quarantine. Methods The study involved 87 Italian Dementia Centers. Patients with Alzheimer’s Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Family caregivers of patients with dementia were interviewed by phone in April 2020, 45 days after quarantine declaration. Main outcomes were patients’ changes in cognitive, behavioral, and motor symptoms. Secondary outcomes were effects on caregivers’ psychological features. Results 4913 patients (2934 females, 1979 males) fulfilled the inclusion criteria. Caregivers reported a worsening in cognitive functions in 55.1% of patients, mainly in subjects with DLB and AD. Aggravation of behavioral symptoms was observed in 51.9% of patients. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioral worsening (odds ratio 1.85 [95% CI 1.42–2.39], 1.84 [95% CI 1.43–2.38], respectively). On the contrary, pandemic awareness was a protective factor for the worsening of cognitive and behavioral symptoms (odds ratio 0.74 [95% CI 0.65–0.85]; and 0.72 [95% CI 0.63–0.82], respectively). Approximately 25.9% of patients showed the onset of new behavioral symptoms. A worsening in motor function was reported by 36.7% of patients. Finally, caregivers reported a high increase in anxiety, depression, and distress. Conclusion Our study shows that quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers’ burden. Our findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia.
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Affiliation(s)
- Innocenzo Rainero
- Aging Brain and Memory Clinic, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.,Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Amalia C Bruni
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
| | - Camillo Marra
- Memory Clinic, Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Chiara Cupidi
- CDCD Ospedale del Delta, AUSL Ferrara, Ferrara, Italy
| | - Valentina Laganà
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
| | - Elisa Rubino
- Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Vacca
- Aging Brain and Memory Clinic, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Raffaele Di Lorenzo
- Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ, Catanzaro, Italy
| | - Paolo Provero
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.,Center for Omics Sciences, IRCCS S. Raffaele Scientific Institute, Milan, Italy
| | - Valeria Isella
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | | | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ildebrando Appollonio
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | | | - Cinzia Bussè
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Renato Sambati
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Davide Quaranta
- Memory Clinic, Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Guglielmi
- Memory Clinic, Fondazione Policlinico Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Neurorehabilitation Unit, and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gioacchino Tedeschi
- Department of Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Ferrarese
- Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
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18
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Zauszniewski JA, Burant CJ. Resourcefulness as a Mediator of the Effects of Dementia Symptoms and Caregiver Reactions on Caregiver Mental Health. Issues Ment Health Nurs 2020; 41:486-493. [PMID: 32255406 PMCID: PMC7314645 DOI: 10.1080/01612840.2019.1693670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this secondary analysis of 138 community-dwelling women caregivers of persons with dementia, we examined whether caregiver resourcefulness mediated the effects of both the frequency of and reactions to their care recipients' memory-related, depressive, and disruptive symptoms of dementia on caregiver depressive symptoms. Caregiver resourcefulness mediated the effects of care recipient depressive symptoms on caregiver depressive symptoms, and the effects of caregiver actions to depressive and disruptive symptoms on caregiver depressive symptoms. The findings suggest the potential benefit of teaching resourcefulness skills to reduce depressive symptoms of caregivers whose care recipients frequently exhibited depressive or disruptive symptoms associated with dementia.
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Affiliation(s)
- Jaclene A Zauszniewski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christopher J Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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19
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Cao Y, Yang F. Objective and Subjective Dementia Caregiving Burden: The Moderating Role of Immanent Justice Reasoning and Social Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020455. [PMID: 31936738 PMCID: PMC7014207 DOI: 10.3390/ijerph17020455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/22/2022]
Abstract
Caregiving burden significantly effects the physical and mental health of family dementia caregivers. While the association between objective caregiving burden (OCB) and subjective caregiving burden (SCB) of family dementia caregivers is well documented, little is known as with how the association is moderated by the configuration of intrapersonal resource (e.g., immanent justice reasoning) and interpersonal resource (e.g., social support). The present study collected cross-sectional data on 157 major family caregivers of non-institutionalized persons with dementia in an urbanizing region of Western China’s Sichuan Province. They responded to questions on daily time spent on caregiving, the short version of Zarit Burden Interview (ZBI), a sub-scale of a caregiver meaning scale, Social Support Rating Scale (SSRS), and demographic questions. Controlling for the demographic variables of the caregivers, this study found that the objective and subjective dementia caregiving burden were significantly associated (p < 0.001), and immanent justice reasoning was positively correlated with subjective burden (p < 0.01). Moreover, the association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both high (p < 0.001), but neutral when social support was high and immanent justice reasoning was low. The association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both low (p < 0.05), but neutral when social support was low and immanent justice reasoning was high. This research suggests the importance of developing intervention programs that consider the configuration of the external supporting resources and internal meaning-making of caregiving of the family dementia caregivers.
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Affiliation(s)
- Yanchun Cao
- Faculty of Economics and Management, East China Normal University, Shanghai 200062, China;
| | - Fan Yang
- School of International and Public Affairs, China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200030, China
- Correspondence:
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20
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Orhan IE, Senol Deniz FS, Traedal-Henden S, Cerón-Carrasco JP, den Haan H, Peña-García J, Pérez-Sánchez H, Emerce E, Skalicka-Wozniak K. Profiling Auspicious Butyrylcholinesterase Inhibitory Activity of Two Herbal Molecules: Hyperforin and Hyuganin C. Chem Biodivers 2019; 16:e1900017. [PMID: 30891904 DOI: 10.1002/cbdv.201900017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/19/2019] [Indexed: 12/15/2022]
Abstract
Cholinergic therapy based on cholinesterase (ChE) inhibitory drugs is the mainstay for the treatment of Alzheimer's disease. Therefore, an extensive research has been continuing for the discovery of drug candidates as inhibitors of acetyl- and butyrylcholinesterase. In this study, two natural molecules, e. g. hyperforin and hyuganin C were tested in vitro for their AChE and BChE inhibitory activity. Both of the compounds were ineffective against AChE, whereas hyperforin (IC50 =141.60±3.39 μm) and hyuganin C (IC50 =38.86±1.69 μm) were found to be the highly active inhibitors of BChE as compared to galantamine (IC50 =46.58±0.91 μm) which was used as the reference. Then, these molecules were further proceeded to molecular docking experiments in order to establish their interactions at the active site of BChE. The molecular docking results indicated that both of them are able to block the access to key residues in the catalytic triad of the enzyme, while they complement some of the hydrophobic residues of the cavity, what is consistent with our in vitro data. While both compounds were predicted as mutagenic, only hyuganin C showed hepatotoxicity in in silico analysis. According to whole outcomes that we obtained, particularly hyuganin C besides hyperforin are the promising BChE inhibitors, which can be the promising compounds for AD therapy.
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Affiliation(s)
- Ilkay Erdogan Orhan
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, 06330, Ankara, Turkey
| | - F Sezer Senol Deniz
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, 06330, Ankara, Turkey
| | | | - José P Cerón-Carrasco
- Bioinformatics and High Performance Computing Research Group, Universidad Católica San Antonio de Murcia (UCAM), 30107, Guadalupe, Spain
| | - Helena den Haan
- Bioinformatics and High Performance Computing Research Group, Universidad Católica San Antonio de Murcia (UCAM), 30107, Guadalupe, Spain
| | - Jorge Peña-García
- Bioinformatics and High Performance Computing Research Group, Universidad Católica San Antonio de Murcia (UCAM), 30107, Guadalupe, Spain
| | - Horacio Pérez-Sánchez
- Bioinformatics and High Performance Computing Research Group, Universidad Católica San Antonio de Murcia (UCAM), 30107, Guadalupe, Spain
| | - Esra Emerce
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Gazi University, 06330, Ankara, Turkey
| | - Krystyna Skalicka-Wozniak
- Department of Pharmacognosy with Medicinal Plant Unit, Medical University of Lublin, 20-093, Lublin, Poland
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