Determinants of informal care-giving in various social relationships in the Netherlands

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.

Determinants of Caregiver Burden Among Spouses of Patients With Kidney Failure: A Qualitative Study

RATIONALE & OBJECTIVE

Spousal caregivers participate extensively in the care of patients with kidney failure. Although previous studies suggested that these caregivers experience a high burden, a comprehensive understanding of the determinants of this burden and strategies to alleviate it are needed. Therefore, this study sought to explore the contributing and alleviating determinants of burden in spousal caregivers of patients with kidney failure.

STUDY DESIGN

A qualitative interview study with 15 spousal caregivers.

SETTING & PARTICIPANTS

Dutch-speaking, adult spousal caregivers were recruited and interviewed by the Dutch Kidney Patients Association for the Kidney Decision Aid.

ANALYTICAL APPROACH

A directed qualitative content analysis using the stress-appraisal model of caregiver burden as a framework to inform a disease-specific model on spousal caregiver burden for kidney failure that characterizes the impact of care provision on all aspects of spousal caregivers' lives, the burden associated with it, and possible mitigating factors.

RESULTS

Providing care for patients with kidney failure is complex and burdensome for spousal caregivers and results in many lifestyle changes, which are largely caused by kidney failure-specific tasks and the shifting responsibility for daily life tasks. Spouses identified disease-specific determinants of burden including the impact of kidney disease on spouses with the disease as well as the associated caregiver tasks, such as adjusting to dietary restrictions and attending dialysis appointments. Dialysis options (eg, the choice for home or in-center dialysis) were kidney failure-specific moderators of burden. Support of spousal caregivers by health care providers plays a key role in preventing overburdening.

LIMITATIONS

Potential limited transferability owing to the study of only Dutch-speaking spouses willing to be interviewed and videotaped.

CONCLUSIONS

This comprehensive overview of the contributing and alleviating determinants of burden experienced by spousal caregivers of patients with kidney failure highlights 4 principal areas: (1) personal and relational, (2) social environment, (3) health care, and (4) work and legislation, in which such burdens occur and may be alleviated.

PLAIN-LANGUAGE SUMMARY

Spousal caregivers are crucial for supporting patients with kidney failure, but they often experience significant stress and challenges. This study explored factors that contribute to spousal caregiver burden and ways to alleviate it. We interviewed 15 spousal caregivers of patients with kidney failure. We found that providing care for patients with kidney failure is complex, burdensome, and has a major impact on caregivers' lives. We identify factors that contribute to caregiver burden but also factors that may ease this burden. This study underlines the need for acknowledgement of spousal caregivers in 4 areas, namely (1) personal and relational, (2) social environment, (3) health care, and (4) work and legislation.

How are location and type of caring associated with the carer's mental health? Cross-sectional and longitudinal findings from SHARE

Research findings on the relationship between caring and health are mixed and call for a more nuanced analysis of the care situation. This study investigates cross-sectional and longitudinal associations between caring and depressive symptoms, considering location and type of care. Data come from the Survey of Health Ageing and Retirement in Europe (SHARE), collected in wave 6 (from 2015 to 2016) and wave 8 (from 2019 to 2020). Cross-sectional data were available for 52.186 respondents in 18 countries. Of these, 18.659 were free of elevated depressive symptoms in wave 6 and were used to investigate incident depression in the longitudinal analyses. We distinguished between personal care, practical help, and paperwork, and were able to compare in-home and outside-home personal care. For both men and women, findings indicate that in-home personal care is associated with an increased risk of reporting and developing depressive symptoms (after controlling for age, country affiliation, education, wealth, employment situation, and functional limitations). Cross-sectional, but not longitudinal, associations were also found for outside-home care in terms of personal care or paperwork, but not for practical help. Additionally, women and disadvantaged population groups were more likely to provide in-home care, but less likely to provide outside care (regardless of the type). Overall, the results highlight that different locations and types of care are associated differently with mental health. Findings also underscore the need for interventions specifically tailored to support disadvantaged populations who provide in-home care, addressing the unique challenges they face.

Who came to the rescue? Sources of informal support to older Europeans before, during and after the COVID-19 pandemic

BACKGROUND/OBJECTIVE

The COVID-19 pandemic disrupted the provision of informal care in major ways. This study documents the prevalences of informal support with (instrumental) activities of daily living (IADL and ADL) before, during and after the pandemic, distinguishing between children, other relatives and friends/neighbours and focusing on individuals 50 years and older across 27 European countries.

METHODS

This longitudinal analysis relies on the Survey of Health, Ageing and Retirement in Europe (SHARE)'s Wave 8 (2019), two Corona surveys (2020 and 2021) and Wave 9 (2022). Linear probability models adjusted for individual fixed effects and time-varying confounders were used to estimate prevalences of informal support over time.

RESULTS

During the pandemic, the prevalences of informal support with both IADL and ADL from all three groups of caregivers increased significantly (P < 0.01), to return to their pre-pandemic levels by 2022. For example, the adjusted likelihood of IADL help from children increased from 18.5% (2019) to 36.6% (2020) and 42.5% (2021), then dropped back to 19.7% in 2022. Friends and neighbours played a critical role, with the adjusted likelihood of IADL help going from 8.8% (2019) to 29.7% (2020), then down to 18% (2021) and 8.9% (2022).

CONCLUSIONS

Future emergency and disaster preparedness plans should contemplate the various sources of informal care, including support measures to non-relative caregivers, as those helpers may be able to rapidly respond to unexpected crisis.

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.].

The Economic Costs of Informal Care: Estimates from a National Cross-Sectional Survey in The Netherlands

Faced with an unprecedented demand for long-term care, European health care systems are moving towards mixed care models, where the welfare state and informal caregivers share care responsibilities. While informal care is often viewed as a means of alleviating pressure on public care, it comes with significant economic costs for caregivers, their employers, and society at large. This study uses nationally representative data to estimate the total direct (informal care time and out-of-pocket costs) and indirect (productivity) economic costs of informal care in the Netherlands in 2019. Informal care time costs are estimated using the opportunity cost and the proxy good methods. Indirect costs are estimated using the human capital and friction cost approaches. Our results reveal the considerable annual societal cost of informal care in the Netherlands, ranging between €17.5 billion and €30.1 billion, depending on the valuation approach. These costs are equivalent to 2.15% and 3.71% of Dutch GDP in 2019, comparable to the public expenditure on long-term care in that year. Female caregivers account for slightly more than half (53%-57%) of the total costs. Around 57%-88% of these costs are in the form of informal care time. The main driver of indirect costs is the temporary cessation of work, which comprises 12%-17% of the total costs. Findings corroborate that substantial resources, yet thus far largely disregarded, are spent on informal care even in a country with a relatively generous public long-term care system.

Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states

PURPOSE

We aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health.

MATERIALS AND METHODS

Using information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale.

RESULTS

Only 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent.

CONCLUSIONS

Informal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.

Childhood Adversities and Caregiving for Older Parents: Building Capacity for a Caring Society

OBJECTIVES

This study investigates the relationships between childhood adversities and the provision of informal care for older parents in later life in China.

METHODS

The data came from 4 waves of the China Health and Retirement Longitudinal Study (N = 20,047). Using multilevel logistic regression models, we examined the relationships between adverse experiences in childhood and both the propensity and intensity of caregiving for older parents. Drawing on the regression results, we then estimated the total number of caregivers for older parents in China.

RESULTS

Experiencing 1 additional childhood adversity was associated with a decrease of 8% in the odds of providing informal care (p < .001). The association between childhood adversity and caregiving remained significant after sociodemographic factors and later-life outcomes were controlled for. We estimated that 58.3 million middle-aged adults in China were providing care for parents in 2020. Had people experienced 1 fewer adversity in their childhood, there would have been 2.2 million more caregivers in 2020. Had they experienced 2 fewer adversities, there would have been 3.4 million more caregivers.

DISCUSSION

The factors associated with informal caregiving can be traced back to early-life experiences. To address the shortage of informal care supply, it is crucial to foster a caring culture from the very beginning of human development.

Families' importance in nursing care-families' opinions: a cross-sectional survey study in the homecare setting

BACKGROUND

Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding family members' opinions about their involvement in care. To date, no instruments have been developed that accurately measure these opinions. This study aims to elucidate the opinions of family members about their involvement in nursing care.

METHODS

A cross-sectional survey approach was employed. The methodological steps in this study were (1) convert the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) from a nurses' perspective to a family perspective and thus develop the Families' Importance in Nursing Care-Families' Opinions (FINC-FO) and (2) measure families' opinions regarding their involvement in home nursing care. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%.

RESULTS

The developed FINC-FO questionnaire showed homogeneity and internal consistency. The results of the questionnaire indicate that family members consider it important to be involved in care and that they wish to be acknowledged as participants in discussions about care (planning) but are less inclined to actively participate in the provision of care by nurses. Family members expressed less explicit opinions about their own support needs. Factors such as level of education, type of partnership, and amount of care provided are seemingly associated with these opinions.

CONCLUSIONS

Family members in the homecare setting wish to be involved in discussions about care (planning). The transition in care from primarily formal to more informal care necessitates an awareness and clear definition-on part of both healthcare professionals and families-of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensure quality of care and that the family can sustain caregiving.

How do urban green spaces influence heat-related mortality in elderly? A realist synthesis

BACKGROUND

An important consequence of climate change for urban health is heat-related mortality. Vulnerable groups, especially elderly, will be the most affected. A solution put forward in many reports and policy documents is the introduction or expansion of urban green spaces. While they have a proven effect in decreasing the ambient temperature and reducing heat related mortality, the causal pathways are far from clear. Moreover, results vary for different contexts, population types and characteristics of green spaces as they are 'complex systems thrusted into complex systems'. To our knowledge, there is no systematic synthesis of the literature that examines the mechanisms by which and the circumstances under which green spaces work to decrease heat-related mortality for elderly.

METHODS

We performed a realist synthesis- a theory-driven review method- to develop a complexity- and context-sensitive program theory. As a first step, a causal loop diagram was constructed which describes the possible pathways through which urban green spaces influence heat-related mortality in elderly. In a second step, one of the pathways - how they may lead to a reduction of heat-related mortality by increasing social capital - was further explored for underlying mechanisms, the context in which they work and the differentiated patterns of outcomes they generate. Literature was searched for evidence supporting or contradicting the initial programme theory, resulting in a refined theory.

RESULTS

Results show how urban green space can impact on heat-related mortality in elderly by its influence on their exposure to outdoor and indoor heat, by improving their resilience as well as by affecting their access to treatment. Urban green spaces and their interactions with social capital affect the access to health information, social support, and the capacity for effective lobbying. Several mechanisms help to explain these observed demi-regularities, among others perceived behavioural control, perceived usefulness, receptiveness, ontological security, and self-interest. If and how they are triggered depends on the characteristics of the urban green space, the population, and other contextual factors.

CONCLUSION

Looking into the impact of urban green spaces on heat-related mortality in elderly, researchers and policy makers should take interest in the role of social capital.

Quality of Life and Health Determinants of Informal Caregivers Aged 65 Years and Over

Informal caregivers' own quality of life, health status, and determinants are poorly understood despite their concern for the health of the individuals they assist. To compare the quality of life and the health determinants of older informal caregivers with those of older adults without caregiving responsibilities. An online survey was designed to investigate the quality of life and the health determinants of people aged 65 years and over, with a focus on informal caregivers. In addition to socio-demographic data, the number of informal caregivers was ascertained and the Zarit scale of caregiver burden was applied. Quality of life (SF-12) and health determinants (access to technology and level of physical activity (IPAQ)) were assessed and compared between informal caregivers and non-caregivers. A total of 111 participants were included in the study (70 ± 3.83 years, 71.2% women). The majority of respondents (91.8%) were Belgian. One-third of the respondents identified themselves as informal caregivers and declared themselves as having a severe burden (61.9 ± 15.2/88). Socio-demographic characteristics and access to technology were similar between informal caregivers and non-caregivers (p > 0.05). However, informal caregivers had a lower SF-12 score in the mental score domain (44.3 ± 10.2 vs. 50.7 ± 7.0; p = 0.004) and a lower level of physical activity (434 ± 312 METS/min/week vs. 1126 ± 815 METS/min/week; p = 0.01) than their peers. Informal caregivers reported a lower quality of life and a lower level of physical activity than their peers. Given the recognized importance of physical activity for overall health, this survey highlights the need to promote physical activity among older informal caregivers.

Applying dyadic digital psychological interventions for reducing caregiver burden in the illness context: a systematic review and a meta-analysis protocol

INTRODUCTION

Providing informal care to one's romantic partner who is ill may become a highly distressing and demanding task. Based on the innovative dyadic coping model, several support interventions have been developed to alleviate informal caregivers' burden, including both caregivers' and care receivers' needs. Considering the unique challenges characterising the caregiving phenomenon, such as geographical barriers and time restrictions, digital solutions should be considered. However, there is a lack of research examining the effectiveness of dyadic digital solutions. Thus, this review aims to examine the existing literature on the efficacy of dyadic digital psychological interventions designed for caregivers and their care-receivers couples within the illness context.

METHODS AND ANALYSIS

Randomised controlled trials targeting caregivers' burden among dyads of informal caregivers and care receivers will be identified via an electronic search of the following databases: PubMed, Embase, the Cochrane Library, Cinhal, Scopus, PsycINFO, MEDLINE and supplemented by hand searching of previous systematic reviews. The search will be undertaken following the PICO (population, intervention, comparison and outcome) elements. If possible, a meta-analysis will be conducted to examine: (1) the effectiveness of dyadic digital psychological interventions for reducing caregivers' burden (primary outcome) among caregivers who are in a romantic relationship with the care receivers; (2) the effectiveness of dyadic digital psychological interventions on secondary outcomes such as anxiety, depression, stress, quality of life, well-being and self-efficacy among caregivers and care receivers; and (3) moderating effects of clinical and methodological factors on caregivers' burden. Prior to inclusion in the review, retrieved papers will be critically appraised by two independent reviewers. The Cochrane Risk of Bias tool will assess the risk of bias for randomised controlled trials.

ETHICS AND DISSEMINATION

Ethical approval is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publications, presentations at academic conferences and lay summaries for various stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42022299125.

Support for Older Parents in Need in Europe: The Role of the Social Network and of Individual and Relational Characteristics

Background and Objectives

Adult children form the backbone of informal care for older parents. To date, limited attention has been paid to the complex mechanism of providing support to older parents. The present study investigated mezzo- and micro-level correlates of provision of support to older parents. The focus was on the child-parent relationship in childhood and in the present.

Research Design and Methods

Data were derived from the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample comprised respondents who participated in SHARE Waves 6-8 and reported having an unhealthy mother (N = 1,554) or father (N = 478). We used hierarchical logistic regression to address 3 models including individual resources, child-parent characteristics, and social resources. We conducted separate analyses for mothers and fathers.

Results

Providing support to a parent depended primarily on personal resources followed by the quality of the relationship with the parent. A larger social network of the care provider was also related to increased likelihood of providing support. Support to a mother was associated with positive evaluations of the relationship with her in the present and in childhood. At the same time, negative evaluations of the relationship with the father in childhood were negatively related to providing support to him.

Discussion and Implications

The findings point to a multidimensional mechanism, in which adult children's resources are a prominent factor in shaping caregiving behaviors toward their parents. Clinical efforts should focus on adult children's social resources and the quality of the child-parent relationship.

A systematic review comparing cardiovascular disease among informal carers and non-carers

Exposure to chronic stress increases the risk of cardiovascular disease (CVD). Providing informal care is known to be a stressful activity, but it is not clear whether informal caregiving is associated with CVD risk. This systematic review aimed to summarise and assess the quantitative evidence examining the association between providing informal care to others and CVD incidence in comparison with non-carers. Eligible articles were detected by searching six electronic literature databases (CINAHL, Embase, Global Health, OVID Medline, Scopus, and Web of Science). Two reviewers appraised 1887 abstracts and 34 full-text articles against a set of a priori eligibility criteria to identify articles for inclusion. Quality assessment of included studies was performed using the ROBINS-E risk of bias tool. Nine studies were identified that quantitatively assessed the association between providing informal care and CVD incidence in comparison to not providing informal care. Overall, there was no difference in the incidence of CVD between carers and non-carers across these studies. However, within the subgroup of studies that examined care provision intensity (hours/week) higher CVD incidence was observed for the most intense caregiving group compared to non-carers. One study examined only CVD-related mortality outcomes, observing a reduction in mortality for carers compared to non-carers. More research is required to explore the relationship between informal care and CVD incidence.

Public long-term care insurance scheme and informal care use among community-dwelling older adults in China

The public long-term care insurance (LTCI) scheme has been implemented in a few countries. Although the hypotheses of crowding-out, crowding-in and specialisation can facilitate our understanding of the relationship between LTCI and informal care use, existing studies may suffer from reverse causality. Employing a quasi-experimental design, this study examined the policy effect of LTCI on informal care use among community-dwelling older adults in China. Based on the data from three waves of the Chinese Longitudinal Healthy Longevity Survey, a staggered difference-in-differences (DID) with propensity score matching (PSM) approach was used to analyse the impact of LTCI on probability and hours of informal care use. The results showed that, for disabled older adults, LTCI reduced 43.3% of the probability and 82.4% of the weekly hours of informal care. LTCI also exhibited a spillover effect among nondisabled older adults through reducing the probability and weekly hours of informal care by 5.2% and 12.2%, respectively. Therefore, we argue that policymakers can consider rolling out the scheme for the entire country. Meanwhile, measures are needed to avoid a sharp decrease in informal care provision.

Testing the informal care model: intrapersonal change in care provision intensity during the first lockdown of the COVID-19 pandemic

Informal care, meaning taking health-related care of people in their own social network, is a topic that gets more and more attention in social science research because the pressure on people to provide informal care is rising due to ageing societies and policy changes. The Informal Care Model developed by Broese van Groenou and de Boer (Eur J Ageing 13(3):271-279, 2016) provides a theoretical foundation to understand under what conditions a person provides informal care. We test this theoretical model by applying it to intrapersonal changes in informal care provision during the first COVID-19 lockdown in the Netherlands in Spring 2020. Data from the LISS panel from two time points, March 2020 and data from July over the period of April/May 2020, were analysed with multinominal multilevel regression analysis (N = 1270 care situations of 1014 caregivers). Our results showed that the individual determinants (Do I have to?, Do I want to?, and especially Can I?) discussed in the Informal Care Model (apart from a series of control variables) are contributing substantially to the understanding of intrapersonal changes in care provision during the first lockdown and by that, we found empirical support for the theoretical model. We conclude that on top of its original purpose to explain between-individual differences in informal caregiving using static indicators, the Informal Care Model is also useful to explain intrapersonal changes in informal caregiving using dynamic indicators.

The Working Informal Caregiver Model: A Mixed Methods Approach to Explore Future Informal Caregiving by Working Caregivers

A growing number of informal caregivers of older adults combine caregiving with a paid job, raising the question of whether they will be able to meet the increasing demand for informal care. The aims of our study are twofold: first, to describe the development of a model providing insight into the factors that play a role in the availability and provision of informal care by working caregivers of older adults, and second, to investigate which societal developments will impact the factors in the model, and thus the future availability of informal care by workers. A mixed-methods approach was applied to integrate evidence from academic and grey literature, with insights from experts through a Group Model Building exercise and a Delphi study. The resulting Working Informal Caregiver (WIC) model presents a range of individual, social and environmental factors that are related to working caregivers’ ability and their willingness to engage in informal care. Experts foresee that future informal care will be impacted most by the increasing participation of women in the workforce, while changing household structures may diminish opportunities to share care tasks within their households or families. The WIC model can be used to gain better insight into the availability of informal care by workers, now and in the future.