Caregiving experiences, coping strategies and needs of foreign domestic workers caring for older people

Experiences of live-in migrant caregivers providing long-term care for older adults at home: A qualitative systematic review and meta-ethnography

BACKGROUND

Live-in migrant caregivers have been employed in various developed countries to meet the growing demands of long-term care needs for older adults. Increasingly, nurses in these countries are involved in providing caregiving training to these live-in migrant caregivers. A comprehensive understanding of the caring experiences of these live-in migrant caregivers can better support their caregiving experiences and improve their quality of care.

AIM

To synthesise the experiences of live-in migrant caregivers for older adults requiring long-term home care.

DESIGN

Qualitative systematic review using meta-ethnography.

METHODS

PubMed, CINAHL, Embase, Google Scholar, PsycINFO, Scopus, ProQuest and Web of Science Core Collection were searched from inception to November 2024. Qualitative studies that explored the experiences of migrant caregivers providing live-in care to older adults requiring long-term care were included. Two reviewers screened the articles according to the eligibility criteria, appraised the articles using the Critical Appraisal Skills Programme Tool, and extracted qualitative data independently. Data synthesis was performed using Noblit and Hare's meta-ethnography.

RESULTS

Five themes emerged from the 14 included studies: beyond caring for the older adult, compromising basic rights, being away, coping strategies, and being a better caregiver. These themes contributed to the overall line-of-argument synthesis: 'Treat me as a human being' so that I can grow and 'give my all' - beyond a transactional paid job to provide care. The synthesis revealed the vulnerabilities, challenges, opportunities, and capacity development encountered by live-in migrant caregivers in unleashing their potential to be better caregivers.

CONCLUSION

The findings highlighted the complexities of care intertwined in social structural bounded relationships between live-in migrant caregivers, older care recipients, and employers. Greater advocacy is needed to embrace live-in migrant workers as valued care providers of the eldercare workforce. Nurses have a role in promoting the development, delivery, uptake, and evaluation of structured, culturally contextualised and comprehensible long-term care training programs for live-in migrant caregivers and their employers. Significant opportunities could be provided to equip live-in migrant workers in caregiving roles, ensure and allocate time to rest, communicate their caregiving needs and moderate employers' expectations. Enhancing the quality of caregiving, improving their intertwined relationships and exercising cultural sensitivity contribute to better caregiving experiences and well-being for older adults, migrant caregivers, and employers.

REGISTRATION AND REPORTING CHECKLIST

The study protocol of this review was registered in PROSPERO (CRD42023392767). The eMERGE meta-ethnography guideline was adhered to.

Experiences of Migrant Live-in Caregivers in Caring for Patients With Advanced Cancer - A Qualitative Study

INTRODUCTION

Foreign domestic workers are increasingly hired in Singapore as live-in caregivers for patients with advanced cancer. Language barriers and different cultural backgrounds can make caregiving potentially challenging. This study aims to explore the experiences of migrant live-in caregivers caring for patients with advanced cancer.

METHOD

Semi-structured interviews were conducted to explore: the challenges and needs of migrant live-in caregivers caring for patients with advanced cancer, what enables their cancer caregiving work, and their motivations. Participants were recruited from inpatient oncology wards of an acute tertiary hospital. Inclusion criteria included: (i) migrant live-in caregiver caring for a patient with stage IV solid organ cancer; (ii) age ≥21 years; (iii) conversant in English, Mandarin or Burmese. Twelve female caregivers participated in the study. Their mean age was 35.4 years, 4 were from Indonesia, 3 from Myanmar and 5 from the Philippines.

RESULTS

Four main themes emerged: (1) Wide-ranging work responsibilities that could be challenging, (2) Treating and being treated like family, (3) Having access to multiple sources of support and (4) Motivated by being able to provide for their own family of origin.

CONCLUSION

Migrant live-in caregivers face various challenges in cancer caregiving. Having a good relationship with patients, adequate employer and peer support and being able to provide for their family helped to motivate them. Efforts to support them can include formal training, better delineation of job scope and hours, and resources to address psycho-emotional needs. Further research could focus on knowledge gaps for cancer caregiving, psychosocial and post-bereavement needs.

Coping, surviving, or thriving: A scoping review examining social support for migrant care workers through four theoretical lenses

RATIONALE

Migrant care workers (MCWs) play a crucial role in addressing healthcare workforce shortages in many developed countries. Existing reviews document the significant challenges MCWs face-such as language barriers, interpersonal discrimination, and sexual harassment-and describe the social support that MCWs receive, but ambiguous application and heterogeneous measurement of theoretical constructs have thus far precluded researchers from deriving generalizable insights about how various types of social support positively and negatively impact MCWs' well-being. Therefore, we conducted a scoping review on this topic and organized the literature using four theoretical perspectives on social support.

OBJECTIVE

To synthesize interdisciplinary research on social support for MCWs and extend existing reviews, we conducted a scoping review of 56 empirical studies to understand how these studies conceptualize and operationalize social support for MCWs and the theoretical and methodological approaches they adopt.

FINDINGS

Our findings suggest that scholars have implicitly and explicitly adopted a wide array of theoretical perspectives (e.g., stress and coping, social constructivism), with few studies engaging theories in substantive ways. The reviewed studies have demonstrated both positive and negative implications of social support for MCWs' well-being. However, these studies heavily focus on the social support MCWs receive, whereas the negative impacts of MCWs' unmet support needs remain under-investigated. Although empirical studies use diverse methodologies to study this topic, most quantitative studies approach social support from a stress and coping perspective. We advocate for researchers conducting quantitative studies to adopt a critical consciousness and work toward statistically modeling how the intersectionality of MCWs' identities and the multi-level nature of MCWs' power positions within their social networks may impact whether MCWs successfully obtain the support they need to thrive.

Live-In Migrant Care Workers as Part of the Long-Term Care Workforce in Taiwan, Singapore, and Austria: Implications for Home-Based Dementia Care

The demand for home-based eldercare, especially for those with dementia, has been growing as societies age; in this context, the acute shortage of local care labor has resulted in the use of migrant workers in many countries. Taiwan, Singapore, and Austria, all emphasizing the family's responsibility for eldercare, have long histories of recruiting migrant workers for home-based eldercare. However, cases of mistreatment of migrant caregivers and care recipients have aroused public concern regarding migrant workers' care capabilities and working conditions. Migrant caregivers have also reported that their lack of care skills and sufficient rest hamper their work with care recipients who have dementia. This commentary provides a critical review of the laws and policies pertaining to live-in migrant care workers' care capabilities and working conditions; the effects of such legal frameworks; and recent changes in Taiwan, Singapore, and Austria. This article enhances our cross-country understanding of the advantages and disadvantages of using foreign labor for eldercare in private homes. Governments should enact legislation that supports live-in migrant care workers' care capabilities and welfare, thereby also improving the well-being of care recipients and their families.

Addressing the overlooked: Integrating oral healthcare in a geriatric care system: Insights from Singapore

Oral health of the older population has long been overlooked in global healthcare agenda. Limited access to oral healthcare for dependent older adults results in poor oral health, negatively impacting their quality of life, nutrition and overall well-being. Especially for nations experiencing rapid ageing population, efforts must be urgently made to integrate oral healthcare services into the current healthcare system and policy. Singapore stands out as one of the most rapidly ageing nations in Southeast Asia, achieving remarkable progress in the healthcare field, as well as advancements in social modernization and economic growth. It now faces the growing burden of the dependent older population and is required to respond to the complex challenges associated with providing holistic eldercare services and ensuring the well-being of its ageing population. This narrative review offers an overview of Singapore's current healthcare policy and system development for the older population, with a specific focus on oral healthcare. The goal is to shed light on this underexplored area, highlighting the challenges that need to be tackled to improve the accessibility of oral health services for dependent older adults.

Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers

BACKGROUND

Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change.

AIM

This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers.

METHODS & PROCEDURES

Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement.

RESULTS

Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology.

CONCLUSION

These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers.

WHAT THIS PAPER ADDS

What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.

The social determinants of migrant domestic worker (MDW) health and well-being in the Western Pacific Region: A Scoping Review

The health and well-being of transnational migrant domestic workers (MDWs) is a pressing but largely neglected public health concern. The Asia Pacific region is home to over 20% of the global MDW population. Living and working conditions, social contexts, political environments, and migration regimes are recognized as consequential to the health of this population, but currently no synthesis of available literature to prioritize research or policy agenda setting for MDW has yet been conducted. This scoping review screened 6,006 peer-reviewed articles and 1,217 gray literature sources, identifying 173 articles and 276 gray literature sources that reported key MDW health outcomes, social determinants of health, and related interventions. The majority of identified studies were observational and focused on the prevalence of common mental disorders and chronic physical conditions, with most studies lacking population representativeness. Identified social determinants of health were primarily concerned with personal social and financial resources, and health knowledge and behaviors, poor living and working conditions, community resources, experienced stigma and discrimination, poor healthcare access, exploitation within the MDW employment industry, and weak governance. Six interventional studies were identified that targeted individual-level health determinants such as financial and health knowledge with mixed effectiveness. Future population representative epidemiological and respondent driven sampling studies are needed to estimate population health burdens. In addition, randomized control trials and public health intervention studies are needed to improve women's health outcomes and address proximal health determinants to reduce health inequalities. Leveraging social networks and community facing non-governmental organizations (NGOs) are promising directions to overcome access to care for this population.

Migrant women caregivers' experiences in end-of-life formal care

OBJECTIVE

To describe and understand the experience of Latin American migrant women as caregivers of elderly people in situations of advanced illness and end of life.

METHOD

Qualitative study using Gadamer's hermeneutic phenomenology. Data were collected in 2019 through 9 semi-structured interviews with Latin American women caregivers, who had cared for people at the end of life, in the Province of Granada (Spain).

RESULTS

Two themes emerged: "Migrant caregiver at the end of life" and "And now, what should I do?": the impact of the loss at the economic, emotional and labor level.

CONCLUSION

Care during the end of life of the cared person generates an additional overload to the situation of migrant women. The experience of this stage is related to the bond with the persons cared and their families, which may affect the development of complicated grief and personal problems related to the loss of employment and the absence of economic support.

I see, I learn, I do: Development and evaluation of a video-enhanced nasogastric tube feeding training programme for caregivers

AIM

We examined the effectiveness of a video-enhanced education package in improving caregiver outcomes (number of steps at first feeding attempt, time to achieve competency and knowledge) compared to the current institutional training approach.

DESIGN

Quasi-experiment.

METHODS

From August 2016-June 2017, we recruited 112 caregivers in a Singaporean tertiary hospital. We allocated 72 and 40 caregivers to video-enhanced and standard education, respectively. Median values are reported with interquartile ranges (IQR), and analysed using Mann-Whitney U test.

RESULTS

Caregivers taught with our video-enhanced package performed a median of 7.0 (IQR = 3.5-7.5) out of eight steps correctly at their first attempt, a 40% increase. There was no change in the median number of training sessions but the 75th percentile dropped to 9.3 from 6.0, a 35% reduction. Post-training knowledge improved from a median of 0.5 (IQR = 0-2.0) to 1.0 (IQR = 0-3.0). The video-enhanced package can improve caregivers' knowledge and accelerate their skill competency.

Overlooked by nurses: A scoping review on health stressors, problems and coping of migrant domestic workers

AIM

The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers.

DESIGN

Scoping review using Arksey and O'Malley's five-stage framework.

METHODS

Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation.

RESULTS

Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being.

Perceptions of health and coping strategies among temporary migrant workers in East and Southeast Asia: a systematic review

BACKGROUND

The rate of international migration for the primary purpose of employment has increased exponentially in recent decades. A significant proportion of this global movement takes place across East and Southeast Asia as workers move on a temporary basis from lower-middle-income home countries such as Indonesia, the Philippines, Thailand and Vietnam to high-income host destinations including Hong Kong and Singapore. Relatively little is known about the unique and long-term health needs of this heterogeneous group of people. This systematic review presents an analysis of recent research into the experiences and perceptions of health of temporary migrant workers in the East and Southeast Asian regions.

METHODS

Five electronic databases CINAHL Complete (via EbscoHost), EMBASE (including Medline), PsycINFO (via ProQuest), PubMed and Web of Science, were systematically searched for qualitative or mixed methods, peer-reviewed literature published in print or online between January 2010 and December 2020. Quality of the studies was assessed using the Critical Appraisal Checklist for Qualitative Research published by the Joanna Briggs Institute. Findings from the included articles were extracted and synthesised using qualitative thematic analysis.

RESULTS

Eight articles were included in the review. Findings from this review indicate that multiple dimensions of workers' health is impacted by the processes of temporary migration. In addition, the research reviewed indicated that migrant workers used various strategies and mechanisms to attempt to address their health-related issues and to take better care of themselves. Such agentic practices could help them manage and maintain their health and wellbeing across physical, psychological and spiritual dimensions within the structural constraints of their employment.

CONCLUSIONS

Limited published research has focused on the health perceptions and needs of temporary migrant workers in East and Southeast Asia. The studies included in this review focused on female migrant domestic workers in Hong Kong, Singapore, and the Philippines. These studies provide valuable insights but do not reflect the heterogeneity of migrants moving within these regions. The findings of this systematic review highlight that temporary migrant workers experience high and sustained levels of stress and are exposed to certain health risks which may compromise long-term health outcomes. These workers demonstrate knowledge and skills in managing their own health. This suggests that strength-based approaches to health promotion interventions may be effective in optimising their health over time. These findings are relevant to policy makers and non-government organisations supporting migrant workers.

A Descriptive Qualitative Study of Foreign Caregivers of Older Adult Stroke Survivors

BACKGROUND AND OBJECTIVES

With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families.

RESEARCH DESIGN AND METHODS

By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis.

RESULTS

Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use.

DISCUSSION AND IMPLICATIONS

Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families.

Live-in migrant home care workers in Germany: Stressors and resilience factors

BACKGROUND

Thousands of Eastern Europeans find employment caring for older individuals as transmigrating live-in home care workers in private households in Germany. Studies have shown that the stressors threatening their well-being are multifaceted and include inequalities and a high practical and emotional workload, but research on protective factors is still scarce.

AIM & METHODS

This qualitative descriptive study focuses on both the stressors and factors that promote care workers' well-being and contribute to their psychological resilience. In guideline-based interviews, 14 female and one male care workers were asked about their stressors and the factors that help them cope.

RESULTS

Identified stressors included separation from their own family, strained relationship with either or both the care recipient (dementia) and their relatives (violation of worker´s rights and devaluation of care work), and permanent availability and lack of free time due to a 24-h care schedule. Resilience factors were both external and internal and included positive social relationships, self-determination, experience in care work, and intrinsic job motivation.

CONCLUSION

Live-ins reside in an ambiguous setting, exposed to both structural and individual strains. However, external and internal resilience factors contribute to a generally positive attitude toward their job and indicate the agency of this precariously employed group. A socially anchored appreciation of their work and an officially controlled expansion of free time are mandatory to improve the working conditions of live-in care workers.

Co-living with migrant domestic workers is associated with a lower level of loneliness among community-dwelling older adults: A cross-sectional study

Loneliness (inclusive social loneliness and emotional loneliness) of older adults is a prominent public health issue internationally. Factors consistently associated with loneliness are age, gender, education, living arrangements, social network, and functional status. Intergenerational co-living with spouse and adult children is important for the exchange of social, emotional, practical, and financial support provided to older adults. Co-living with migrant domestic workers (MDWs) to care for older adults became an emergent phenomenon internationally, particularly in Asian countries. According to the convoy model of social relations, the effect of co-living with MDWs on older adults' loneliness is unknown. This study examined (1) the prevalence of loneliness among community-dwelling older adults; and (2) the association between co-living with MDWs and older adult loneliness. Using the Chinese version of the 6-item De Jong Gierveld Loneliness Scale on loneliness, 380 older adults were interviewed at busy points in Hong Kong, including subway stations. 35.3% of older adults experienced moderate-to-severe loneliness. Linear regression was performed to examine the association between co-living with MDWs and loneliness. The results showed that co-living with MDWs was significantly associated with lower levels of overall loneliness (β = -0.636; p = .022) and emotional loneliness (β = -0.298, p = .039), but not for social loneliness (β = -0.337, p = .084). While MDWs could be an attachment figure for older adults, they might not be effective in promoting the social integration of older adults. There is a need to investigate the barriers of social integration faced by older adults co-living with MDWs.

Exploring the Workplace Bullying of Indonesian Caregivers and Its Influencing Factors in Taiwan

Background: Bullying can pose a risk to the health and safety of humans, including the risk of damage to the emotional, psychosocial, mental, or physical health of employees in the workplace. In this study, we aimed to understand the personal characteristics, mental health, sleep quality, and workplace bullying status of Indonesian caregivers and explore the influencing factors of workplace bullying among them. Methods: This cross-sectional study was based on a structured questionnaire in Indonesian, which was designed to collect the data of essential personal characteristics, workplace bullying, sleep quality, and mental health using the Indonesian versions of the Negative Acts Questionnaire−Revised (NAQ-R), Pittsburgh Sleep Quality Index (PSQI), and the Brief Symptoms Rating Scale (BSRS-5). Results: A total of 60.9% of Indonesian caregivers never experienced workplace bullying in Taiwan. A multiple regression analysis revealed that being a household caregiver (β = 0.14, p = 0.021), sleep quality (β = 0.18, p = 0.031), and mental health (β = 0.44, p < 0.001) were significantly correlated with the overall workplace bullying scores of the respondents and revealed that these three variables explained 45% of the variance. Conclusions: Taiwan Indonesian caregivers have a similar workplace bullying rate to Indonesian employees in the workplace. This study indicated the relationships among the workplace bullying of foreign caregivers and demonstrated that being a household caregiver, sleep quality, and mental health were closely related.

A discursive paper on the importance of health literacy among foreign domestic workers during outbreaks of communicable diseases

AIM

Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID-19 pandemic is used as an example.

BACKGROUND

Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio-cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community-based nurses.

DESIGN

A discursive paper.

CONCLUSION

Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay-at-home measures for COVID-19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health-related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations.

RELEVANCE TO CLINICAL PRACTICE

Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required.

Caregiver burden in familial caregivers and foreign domestic workers of patients with traumatic brain injury in a multi-ethnic Asian population

OBJECTIVE

The purpose of this study was to investigate the prevalence and risk factors associated with caregiver burden in familial caregivers and foreign domestic workers of patients with severe traumatic brain injury.

METHODS

A total of 77 caregivers were consecutively recruited, who were either familial caregivers or foreign domestic workers. All caregivers were evaluated with the Zarit Burden Index (ZBI), Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder 7-item (GAD-7) scale. Logistic regression analysis was conducted to determine factors associated with caregiver burden.

RESULTS

The majority of participants were familial caregivers (N = 60), of which 70% experienced significant caregiver burden. In this group, 10.0% caregivers had clinically significant depression and 16.7% caregivers who had clinically significant anxiety. On multivariate analysis, factors found to be associated with caregiver burden were Glasgow Outcome Scale Extended (GOSE) of <7, presence of neuropsychiatric complications, and presence of anxiety. There was also a high prevalence of caregiver burden in foreign domestic workers (29.4%).

CONCLUSION

There is a high rate of caregiver burden in both familial caregivers and foreign domestic workers who care for patients with severe traumatic brain injury. Caregivers experiencing stress should also be monitored for the presence of anxiety or depression.

Demographic Characteristics Associated with the Likelihood to Use Paid Home Care for People with Dementia among South African Muslims

BACKGROUND

In societies where the value of filial piety is observed, a preference for caregiving to take place at home exists. In fact, institutional and paid home care for people with dementia (PWD) are still taboo in some Muslim societies. However, economic development and globalisation have resulted in intergenerational separation, thus impacting the ability by young adults to provide care for the elderly at home.

OBJECTIVE

We establish the demographic characteristics most likely to be associated with the use of paid home care - age, gender, education level, marital status, family structure, experience with dementia care in the family, and number of dependents - for PWD among South African Muslims.

METHODS

A survey, administered in the form of an online questionnaire, of Muslim families across each of the 9 provinces of South Africa was conducted. Multiple logistic regression was used to test the effects of the demographic variables on the type of care choice arrangement (family as primary caregiver vs. paid home caregiving).

RESULTS

422 responses were analysed, 28% of which indicated the respondents' desire to use paid home caregivers. The multiple logistic regression results indicate that South African Muslim families are more likely to use paid home care if they are older (that is, over 40 years; OR = 1.972, 95% CI: 1.445-2.695), are female (OR = 1.637, 95% CI: 1.089-2.457), and have high levels of education (OR = 1.828, 95% CI: 1.070-3.125).

CONCLUSION

Home-based care is touted as the next dementia care model. Given that intergenerational mobility is likely to increase as future generations continue to participate more in the labour market, minority groups with a disposition to the same familial social values will require appropriate support in order to cope with the demands of caring for PWD. Suitable interventions for Muslim families who are not open to using external assistance, as well as those who are, need to be administered to enable the caregiver and care recipient to thrive at home.

Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: A feasibility pilot study

OBJECTIVES

The objectives of this study are to explore the feasibility of a multicomponent intervention programme and to evaluate its impacts on behavioural and psychological symptoms of dementia (BPSD) and psychological health of caregivers.

METHODS

Fifty-six community-dwelling people with dementia (PWD) and knee osteoarthritis (OA) and their caregivers were recruited and randomized into the intervention group (IG) or comparison group (CG). Each participant in both groups received an individual physiotherapy session (personalized home exercises and care education) and underwent 8 weeks of a 1-hour-structured group exercise session weekly at a day care centre. They were instructed to follow the prescribed home exercise. The IG received a multicomponent programme, combining knee OA-specific therapeutic exercise with self-management support, while the CG attended the routine group exercise programme. The attendance rate and reasons for non-attendance were recorded for evaluating the feasibility. The Chinese versions of the Revised Scale for Caregiving Self-Efficacy (RSCSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) were measured at the baseline and postintervention.

RESULTS

Fifty-four dyads completed the programme with high attendance rate (94.4%). Compared with the CG, caregivers in the IG significantly improved in three domains of RSCSE scores (P ≤ .005) and caregivers' distress (P = .004) after the intervention. However, no effects were observed in terms of BPSD severity in PWD. No adverse events or falls were reported.

CONCLUSION

This multicomponent programme is feasible and safe for dementia caregivers and older people with mild-to-moderate dementia and knee OA. The programme has beneficial effects on caregiving self-efficacy and distress of dementia caregivers.