Caregivers to older adults require support: A scoping review of their priorities

Effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Spouses often assume the role of primary informal caregivers for ageing partners. Spousal caregivers are more likely than other family members to experience negative psychological outcomes due to their unique identities. However, little is known as to whether psychoeducation interventions can support them in the caregiving process.

OBJECTIVES

To systematically identify and synthesise evidence regarding the effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

Eight electronic databases, including Cochrane Library, PubMed, CINAHL, MEDLINE, Embase, PsycINFO, Chinese Journal Net and Wanfang were searched from inception to August 2024. Randomised controlled trials of psychoeducation interventions on psychological outcomes in spousal caregivers of older adults were included. The quality of the evidence was evaluated using The Cochrane Risk of Bias Tool v2. The certainty of the evidence was assessed by the GRADE approach. Data synthesis methods, including meta-analysis and narrative synthesis, were conducted based on data availability. Meta-analysis was performed using a random-effects model given the substantial heterogeneity in the intervention design and outcomes. Sensitivity analyses were used to assess the robustness of the findings.

RESULTS

Among the 18 reviewed studies, the overall risk of bias indicated that four had low risk, eight had some concerns, and six had high risk. The pooled analysis suggested that psychoeducation interventions had significant effects on improving marital satisfaction (SMD = 0.28, 95 % CI: 0.09 to 0.47; low certainty) and positive aspects of caregiving (SMD = 1.30, 95 % CI: 0.44 to 2.16; very low certainty). However, the effects on depressive symptoms, caregiving burden, anxiety, mental health, coping and self-efficacy were negligible. Narrative synthesis of evidence suggested potential beneficial effects on posttraumatic growth, family functioning, family relationship and life satisfaction.

CONCLUSIONS

Psychoeducation interventions have potential to improve marital satisfaction and positive aspects of caregiving among spousal caregivers of older adults. However, the evidence has a low level of certainty with considerable variability in intervention design and outcome measures, indicating the need for further rigorous investigation. The non-significant effects on enhancing caregiving competence or alleviating negative psychological outcomes highlight the importance of exploring the specific needs and expectations of spousal caregivers.

REGISTRATION

PROSPERO (CRD42024498599).

Characterizing primary care patient referrals and attendance patterns for virtual lifestyle medicine shared medical appointments

Objective

To better understand patient engagement in a Lifestyle Medicine Shared Medical Appointment.(LMSMA) program with Health and Wellness Coaching (HWC).

Methods

From July 2022 to June 2023, adult patients were referred to the Massachusetts General Hospital Healthy Lifestyle Program by primary care providers or self-referred in LMSMAs and HWC, both virtual programs supporting lifestyle behavior change. Demographic and clinical data extracted from electronic medical records were analyzed to assess associations with engagement using independent samples t-test, Chi-squared, Fisher exact-test, and odds ratios.

Results

In total, 1315 patients enrolled in LMSMAs and 947 (72.0 %) attended at least one session. Also, 151 patients (15.9 %) attended at least one HWC session. For LMSMAs, age was associated with higher enrollment (OR = 1.02, CI = 1.01-1.03) and attendance (OR = 1.02, CI = 1.01-1.02), male sex was associated with lower enrollment (OR = 0.64, CI = 0.48-0.87) but higher attendance (OR = 1.46, CI = 1.04-2.06). Lower education was associated with lower attendance (OR = 0.42, CI = 0.21-0.83). For HWC enrollment, male sex was associated with higher enrollment (OR = 1.96, CI = 1.19-3.41). Black race (OR = 2.90, CI = 1.36-7.60), Hispanic ethnicity (OR = 2.05, CI = 1.07-4.44), and lower education (OR = 1.71, CI = 1.20-2.46) were associated with higher HWC enrollment.

Conclusions

Primary care provider- and self-referred patients both attend LMSMAs and HWC. Both LMSMAs and HWC may reach a racially and educationally diverse subset of patients. Research is needed to better understand the role that age, sex, race, and ethnicity play in LMSMA and HWC participation.

Attitudes of Australian Veterinary Professionals to Diagnosing and Managing Canine Cognitive Dysfunction

Canine cognitive dysfunction (CCD) is a neurodegenerative disease likely to affect 14% to 35% of dogs over the age of eight years. Although it can be associated with a high burden of care in owners of affected dogs, there is a lack of knowledge of how veterinarians diagnose and manage the disease. The aim of this study was to determine how veterinary professionals (veterinarians and veterinary nurses/technicians) manage CCD and their attitudes towards the disease using an anonymous online survey. Chi-square tests were used to assess differences according to years of experience, and multiple correspondence analysis was used to analyze clusters according to age, gender, and experience. One hundred and four responses were obtained: 73 veterinarians and 31 veterinary nurses/technicians. Veterinarians diagnosed CCD based on their own experience or by excluding other diseases (27/73, 37% and 25/73, 34%, respectively) and mostly diagnosed a few cases/year (34/73, 47%) or a few in their career (19/73, 26%). CCD was managed using specific medication or environmental changes (57/73, 78% and 58/73, 79%, respectively). Over half of veterinarians agreed/strongly agreed that they were confident in diagnosing CCD (49/73, 67%) and in giving advice on symptom management (53/73, 71%), but only 14/31 (45%) of veterinary nurses/technicians agreed that veterinarians in their practice actively treated dogs with CCD. Participants mostly agreed that CCD is associated with a large burden of care for owners, but less than half measured this burden of care. Although veterinary professionals are aware of CCD, the low rate of diagnosis suggests many dogs are undiagnosed. Increased awareness of the disease by the veterinary profession will enhance human and dog welfare.

Maintaining trust and seeking support: a qualitative study of family caregivers' experiences interacting with health care services for home-dwelling older people with mental health problems

BACKGROUND

Enhanced interactions between family caregivers and health care services can improve the care provided to older people and assist caregivers in managing their responsibilities more effectively. However, there are several barriers to involving families in care, and we need more knowledge to understand different aspects of interactions. This study with family caregivers of home-dwelling older people with mental health problems aimed to explore caregivers' experiences and perceptions of their role in interactions with health care services.

METHODS

We conducted individual in-depth interviews with ten family caregivers. Braun and Clark's thematic approach guided the analysis.

RESULTS

We identified two main themes. The first is the balancing act of managing trust: family caregivers navigating the caring role between empowering autonomy and taking responsibility. The second is the caregiver's role in a complex care context: family caregivers seeking knowledge, recognition, and support from professional caregivers.

CONCLUSIONS

Managing older people's trust is pivotal to family caregivers' interactions with health care services. These caregivers carefully balance two crucial aspects: empowering older people's autonomy and ensuring adequate health care by sharing information. To effectively involve families in the care of older people, this study highlights the need for health care services to consider the competence and time required to balance the dual responsibility of providing optimal care for older people while attending to the needs of family caregivers.

Narratives of health-promoting experiences by older husbands and wives providing care to their home-dwelling spouses receiving home-care services in Norway

BACKGROUND

In today's healthcare systems, older family caregivers who care for their spouses at home are indispensable providers of healthcare. However, many of these caregivers are at risk of becoming ill themselves. To prevent this and to guide the development of targeted healthcare services, home-care personnel need knowledge on how to promote the health of older family caregivers. The purpose of this study was to understand the health-promoting experiences of older family caregivers who care for their home-dwelling spouses receiving home-care services.

METHODS

The experiences of older family caregivers were explored using a narrative design that involved narrative interviews and a narrative thematic and structural analytical approach. The sample consisted of four husbands and six wives aged 79-91 years. In the analysis, two storylines of narratives were constructed: one by husbands and one by wives.

FINDINGS

In the husbands' narrative, continuation of everyday life and social support in everyday life were highlighted as being health-promoting. In the wives' narrative, the importance of having time for oneself and being seen, heard and included by the home-care personnel were emphasized as promoting their health. The husbands' narrative contained stories of the past and the present, while the wives' narrative mainly comprised stories of the present.

CONCLUSION

This study has provided insights into the narratives of older husbands and wives acting as family caregivers regarding what promotes their health caring for their spouses at home. Their stories show variations in care style, coping style and experiences of the caregiver burden. These findings suggest that home-care services should consider providing customized health-promoting services to older family caregivers who are providing care to their home-dwelling spouses receiving home-care services. Given the sample size of only ten participants, further qualitative and quantitative research is needed.

The Saskatchewan Caregiver Experience Study: Support Priorities of Caregivers of Older Adults

BACKGROUND

Population aging is a global phenomenon. Many older adults living with chronic conditions rely on family and friend caregivers. The growing demand for family and friend caregivers underscores the necessity for adequate and effective support services.

PURPOSE

The Saskatchewan Caregiver Experience Study sought to gather the perspectives of caregivers of older adults and set priorities for caregiver support.

METHODS

An online survey with open-ended questions was employed in this qualitative descriptive study. In this manuscript, we present our findings from the survey question: "What do you think is most important for support in your caregiving role? In other words, what are your top priorities for support?"

FINDINGS

This survey question received n = 352 responses, evenly distributed across Saskatchewan in urban-large (33%), urban-small/medium (32%), and rural (35%) settings. Support priorities of Saskatchewan caregivers were found to be access to help when they need it; an ear to listen and a shoulder to lean on; assistance in optimizing the care recipient's health; having healthcare professionals that care; and improved policies, legislations, and regulations.

CONCLUSION

Services and interventions that assist caregivers are more likely to be accessed and utilized when caregivers are given the opportunity to identify their own support priorities. This study has the potential to inform health and governmental systems to support caregivers of older adults provincially within Saskatchewan, nationally in Canada, and in a global context.

What do family caregivers of patients with life-threatening diseases need from healthcare professionals? A qualitative study

OBJECTIVES

To explore the common ground of what family caregivers need in their various roles (caregiver, care recipient and patient's partner, child or friend) from healthcare professionals across healthcare settings and disease trajectories.

DESIGN

Interviews were conducted with family caregivers of patients with life-threatening diseases who were treated at home, in hospitals, nursing homes or hospices between 2017 and 2022. Reflexive thematic analysis was performed.

SETTING/PARTICIPANTS

63 family caregivers of 65 patients were interviewed. Of the patients, 36 (55%) had COVID-19 and 29 (45%) had other life-threatening diseases (eg, advanced cancer, dementia). The majority of family caregivers were women (83%) and children of the patient (56%).

RESULTS

Three themes were developed regarding family caregivers' core needs across their different roles: (1) 'feeling seen and valued', (2) 'experiencing trust in the provided care' and (3) 'experiencing guidance and security'. Actions of healthcare professionals that meet those needs relate to their contact and relationship with family caregivers, information provision, practical and emotional support, the care for the patient and facilitating the connection between family caregivers and patients.

DISCUSSION

Healthcare professionals should be trained in meeting family caregivers' core needs, in which their (collaborative) relationship with them plays an important role. Efforts to meet the core needs should be incorporated into healthcare organisations' workflows, and future research should investigate related barriers and facilitators.

Narrative reanalysis: A methodological framework for a new brand of reviews

In response to the evolving needs of knowledge synthesis, this manuscript introduces the concept of narrative reanalysis, a method that refines data from initial reviews, such as systematic and reviews, to focus on specific sub-phenomena. Unlike traditional narrative reviews, which lack the methodological rigor of systematic reviews and are broader in scope, our methodological framework for narrative reanalysis applies a structured, systematic framework to the interpretation of existing data. This approach enables a focused investigation of nuanced topics within a broader dataset, enhancing understanding and generating new insights. We detail a five-stage methodological framework that guides the narrative reanalysis process: (1) retrieval of an initial review, (2) identification and justification of a sub-phenomenon, (3) expanded search, selection, and extraction of data, (4) reanalyzing the sub-phenomenon, and (5) writing the report. The proposed framework aims to standardize narrative reanalysis, advocating for its use in academic and research settings to foster more rigorous and insightful literature reviews. This approach bridges the methodological gap between narrative and systematic reviews, offering a valuable tool for researchers to explore detailed aspects of broader topics without the extensive resources required for systematic reviews.

Healthcare professionals' perceptions on providing support to informal carers within stroke care

BACKGROUND

The sudden nature of stroke onset does not provide carers with sufficient time to prepare for the demands associated with caring. Healthcare professionals can have a vital role in providing carers with support and training, which may reduce carer stress and strain, and allow for better health and rehabilitation outcomes for the stroke survivor. The experiences of healthcare professionals on supporting carers in stroke care, however, remain unclear.

OBJECTIVE

To understand the experiences and perceptions of healthcare professionals working in stroke care on implementing resources and support to informal stroke carers.

METHODS

Semi-structured interviews were conducted with 11 healthcare professionals (5 occupational therapists, 5 physiotherapists, 1 psychologist) with at least 12 months' experience in working with stroke survivors. Interviews ranged from 25-70 minutes in duration, and were recorded, transcribed, and analysed using thematic analysis.

RESULTS

Three overarching categories that were explored were: (1) Experiences of working in stroke care and supporting carers; (2) Recommendations for a program designed for carers; and (3) Future priorities in stroke care. Participants discussed a variety of strategies they utilised to support carers including collaborating with other healthcare professionals and utilising skills and experience. Healthcare professionals highlighted the need for additional resources that are designed specifically for carers and explored key topics including carer stress and fatigue, support services, stroke education, and how to look after oneself. Participants identified priorities for stroke care including additional professional training and resource availability.

CONCLUSION

This study provided a unique insight from the perspectives of healthcare professionals on supporting carers. Participants identified the need for additional training and resources to equip healthcare professionals to better support carers. Future programs designed for carers should be informed by the needs and experiences of both informal carers and healthcare professionals.

Mapping the Caregiver Experience in a Canadian Province: Research Methodology for the Saskatchewan Caregiver Experience Study

BACKGROUND

Policies and services for older adults are increasingly focused on living in the community, rather than relying on institutions. A total of 70-80% of community care for older adults is provided by family and friend caregivers. With Canada's aging population, the number of caregivers to older adults is growing.

PURPOSE

The purpose of this paper is to describe the research methodology that was employed in the Saskatchewan Caregiver Experience Study. The methodology was used to map the experiences and gather perspectives of caregivers in Saskatchewan and to identify their priority support needs.

METHODS

Qualitative description was the approach in this study. An online qualitative survey was administered via SurveyMonkey and distributed via Facebook and community newsletters. The survey collected caregiver demographics and asked three open-ended questions regarding: (1) the challenges that caregivers experience; (2) the positive aspects of caregiving; and (3) the support needs and priorities of Saskatchewan caregivers. A fourth question where caregivers could freely express any other experiences or perspectives was included. Content analysis was the method used for data analysis.

RESULTS

355 individuals met the inclusion criteria for this study. Participants were evenly distributed amongst urban-large, urban-small/medium, and rural settings in Saskatchewan. The average age of caregivers and care recipients were 61 and 83 respectively.

CONCLUSION

This study has implications for research, practice, and policy. By gathering the full spectrum of the caregiver experience in Saskatchewan, this study can help to inform how communities, governments, and our healthcare system can best support caregivers in their role.

The use of ecological momentary assessment for family caregivers of adults with chronic conditions: A systematic review

Background

Ecological momentary assessment (EMA) as a real-time data collection method can provide insight into the daily experiences of family caregivers.

Purpose

This systematic review aimed to synthesize studies involving EMA completed by family caregivers of adults with chronic conditions.

Methods

A systematic search was conducted within six databases for articles published from the inception of the database through September 2023. We extracted the characteristics of the included studies and data on EMA-specific methods to determine the quality of the included studies.

Results

A total of 12 studies involving EMA completed by family caregivers of adults with chronic conditions were identified, with almost all studies focused on caregivers of persons with Alzheimer's or dementia-related conditions. The average compliance rate across the included studies was 75%, below the recommended rate. In addition, most of the included studies did not collect the family caregivers' daily activities and care contexts in their responses (i.e., affect, stress, well-being, care demand, and fatigue) to the EMA prompts.

Discussion

This review showed that using EMA to collect information on family caregivers of adults with chronic health conditions appeared feasible and acceptable. However, the methodology or design of using EMA to collect caregiver information in this population is still preliminary. The limited number of existing studies that have used EMA to capture the daily experiences of family caregivers does not provide key information that could improve understanding of caregivers' emotional experiences and well-being in real-life situations. We identified gaps in the literature that warrant additional EMA studies for this population.