The relationships of job and family demands and job and family resources with family caregivers' strain

Dual Caregiving and Mental Health Among Long-Term Care Nursing Assistants: The Moderating Role of Social Support

AIM

To investigate the association of long-term care nursing assistants' dual caregiving roles with mental health and to determine whether social support moderates this relationship.

DESIGN

A cross-sectional survey.

METHODS

We surveyed 962 certified long-term care nursing assistants working in long-term care and medical facilities across Taiwan from October 2022 to July 2023. 'Dual caregiving roles' denote the fulfilment of caregiving duties both at work and within families. Mental health was evaluated using the 5-item Brief Symptom Rating Scale. Logistic regression analysis was utilized to investigate the association of dual caregiving roles and psychological job demands with poor mental health. Moreover, we explored whether family, colleague, and supervisor support moderated the association between dual caregiving roles and poor mental health.

RESULTS

Among long-term care nursing assistants, 15% had dual caregiving responsibilities. Individuals with both dual caregiving roles and high psychological job demands faced the highest risk of poor mental health compared to those without dual caregiving roles and low psychological job demands. Having dual caregiving roles was associated with poor mental health compared to workers without such roles. Additionally, support from family, colleagues, and supervisors mitigates the association between caregivers' dual caregiving roles and poor mental health.

CONCLUSION

A substantial proportion of long-term care nursing assistants had dual caregiving roles, leading to an additional mental health burden when combined with high psychological job demands. High social support attenuated this association.

IMPLICATIONS FOR THE PROFESSION

Long-term care nursing assistants with dual caregiving roles had poorer mental health outcomes. Yet, support from family, colleagues, and supervisors mitigated these effects. These results emphasize the importance of enhancing social support to protect the mental well-being of long-term care nursing assistants managing both formal and informal caregiving duties.

REPORTING METHOD

This study adheres to the STROBE guideline of reporting.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Care partner needs in Parkinson's disease: A systematic review of qualitative and quantitative data

BACKGROUND

Care for persons with Parkinson's disease (PD) is to a great extent carried out by care partners. It is important to understand their needs to ease their burden and help with their important role.

OBJECTIVE

To present (1) what is known about needs in caregiving for someone with PD from both qualitative and quantitative papers; and (2) to identify research gaps in the existing literature to guide future research.

METHODS

A systematic search was conducted, searching PubMed, CINAHL, PsychINFO, and MEDLINE for both qualitative and quantitative studies examining care partner needs in Parkinson's disease published from the start of the databases up to 13 November 2024. The best-fit framework synthesis method was employed for qualitative data extraction and analysis. The Critical Appraisal Skills Programme (CASP) and the Newcastle-Ottawa Scale (NOS) were used for quality assessment of studies.

RESULTS

Forty-eight qualitative studies, ten quantitative studies, and three mixed methods studies met the eligibility criteria. All studies were of observational, cross-sectional design. A total of nine themes (the need for information, the need to be heard, PD healthcare, emotional support, daily living, financial support, skills, care partner physical well-being, and respite care) were identified from qualitative data and all quantitative data could fit this framework. Quantitative data on the frequency of needs and when they arise over the course of PD were scarce. Only one quantitative study made use of a validated measurement instrument to measure care partner needs, the Family Needs Questionnaire.

CONCLUSIONS

Care partner needs in PD are wide-ranging. A significant gap identified is the absence of quantitative data to determine the prevalence, timing, and factor contributing to the needs revealed by the qualitative research.

The Association Between Disability Status of the Caregivers and Their Perceived Mental Strain: Hong Kong Population-Based Study of Caregivers of Older Adults With Disabilities

OBJECTIVES

This study investigated the association between caregivers' disability status and their mental strain when caring for family members with disabilities. Moreover, we examined the moderating roles of caregiving time and the presence of additional caregivers in this association.

METHODS

Data were selected from a territory-wide survey of people with disabilities in Hong Kong, which included 85,700 family caregivers of people with disabilities. Logistic regression was adopted to test the study hypotheses. Weights were applied for all analyses to ensure the sample was representative of the population.

RESULTS

Caregivers' disability status was associated with higher levels of mental strain among family caregivers of people with disabilities (odds ratio [OR] = 2.58, p < .001). More caregiving hours per week predicted higher risks of caregiving mental strain (20.0-39.9 hr: OR = 3.38, p = .005; 40.0-59.9 hr: OR = 5.01, p = .001; 60.0 hr or more: OR = 9.08, p < .001). The presence of additional caregivers did not reduce the mental strain of primary caregivers. Additionally, no significant moderating effects were observed. However, the results suggest that caregivers with disabilities were more sensitive to the adverse effect of more caregiving time on mental strain.

DISCUSSION

This study highlights the significant impact of caregivers' disability status on mental strain, underscoring the need for targeted social services and policies to reduce caregiving burdens and protect caregivers' health, especially for those with disabilities.

Effects of a workplace participatory approach to support working caregivers in balancing work, private life and informal care: a randomized controlled trial

OBJECTIVES

Many employees combine their work with informal care responsibilities for family and friends, potentially impacting their well-being and sustained employability. This study aimed to investigate the effectiveness of a workplace participatory approach (PA) intervention in supporting working caregivers to prevent and solve problems related to balancing work, private life, and informal care tasks.

METHODS

We conducted a two-armed randomized controlled trial (ISRCTN15363783) in which working caregivers either received the PA (N=57), under guidance of an occupational professional serving as process facilitator, or usual care (N=59). We recruited 125 working caregivers from four Dutch organizations. Questionnaire-based measurements were assessed at baseline, 4, and 7 months. The primary outcome was work-life imbalance. Secondary outcomes were perceived social support from supervisors and colleagues, role overload, distress and perceived burden of combining work and informal care. Intervention effects were analyzed using intention-to-treat analysis and linear mixed models.

RESULTS

The PA was not effective in reducing work-life imbalance, improving support from colleagues or reducing role overload, distress and perceived burden of combining work and informal care. However, the PA significantly improved perceived social support from supervisors at 4 months [β=0.54, 95% confidence interval (CI) 0.21-0.88] and 7 months (β=0.36, 95% CI 0.02-0.70). Interaction effects indicated that improvement in supervisor support varied depending on the organization.

CONCLUSION

The PA improved supervisor support but not work-life imbalance. Further research should explore PA effects on working caregivers with and without balance issues and the role of supervisor support in reducing work-life conflict.

[Role and function of social support in family post-caregivers of dependent persons]

INTRODUCTION AND OBJECTIVE

Social support appears to have a positive impact on the mental health and well-being of post-caregivers. Therefore, the aim of this paper is to examine the perceived social support network and its role in post-caregiving.

MATERIALS AND METHODS

56 family post-caregivers of older people participated in a semi-structured interview. In addition, the Social Support Questionnaire -MOS- and qualitative measures were applied. Descriptive analyses of the relationship between variables were carried out. At the qualitative level, we worked with a phenomenological design using the NVIVO program. Finally, data were triangulated using the mixed concurrent triangulation design methodology (DITRIAC).

RESULTS

Post-care adjustment was positively associated with the dimensions of the perceived social support scale. The network of friends was found to be supportive during the loss, generating spaces for leisure and recreation that allowed post-caregivers to resume their social life. The family unit can move closer or further away. Children played a role of support and companionship for the post-caregivers and are also a source of motivation to cope and adapt to the loss of the cared-for relative. Participants emph asised the need to feel listened to and welcomed. 64.3% of participants referred to not having received psychological care.

CONCLUSIONS

It is essential to carry out interventions that favor the development and maintenance of the family caregiver.

Attitudes of Arab Family Caregivers in Israel Toward Robot-Delivered Care For ADL-Dependent (Activities of Daily Living-Dependent) Older People: Identifying Ethical and Social Issues

Older people are often cared for by family caregivers who may experience a variety of challenges. Robots may be helpful. Understanding the attitudes of family caregivers in this context is essential as they are a major factor in robot use. To date, most studies on family caregivers ' attitudes toward robot assistance in elder care have been conducted in East Asian or Western societies, but as such perceptions are affected by culture, in the present study, we investigated the attitudes of Arab family caregivers in Israel. Semi-structured interviews were conducted with twenty Arab family caregivers who provide care to ADL (activities of daily living)-dependent older people. All participants were Muslim and adult children of a person requiring care. The majority (75 per cent) were women, and the average age was fifty-one. Analysis of the interviews revealed two main themes: (1) Attitudes: Most participants strongly objected to the assistance of a robot in caring for older people, and perceived it as a violation of family values; and (2) Reasons for attitudes: Participants preferred human care over robot care due to concerns previously documented among other populations regarding system malfunctions, the risk of loneliness, and lack of technological literacy. We also identified a unique factor: the family 's moral obligation to care for older people. The absolute opposition of family members to the use of a robot in the care of older people requires the development of intervention programmes to increase technological literacy among family caregivers and reduce negative attitudes. These programmes need to address the opportunities and risks associated with the use of robots, and how these risks can be avoided.

"Try to keep things going" - Use of various resources to balance between caregiving and other aspects of life: An interview study with informal caregivers of persons living with brain tumors in Sweden

PURPOSE

Persons living with brain tumors may experience severe impairment, requiring social support (i.e., informal care). Although informal caregiving can be rewarding, it can also lead to physical or psychological burdens. The aim of this study was to explore how informal caregivers of persons living with brain tumors use resources available to them, including social support, to balance caregiving with other aspects of life.

METHODS

Sixteen informal caregivers (14 partners, two adult children) of persons living with brain tumors, varied in gender (10 female, six male), age (26-79 years), and caregiving experience (1-20 years) were interviewed. Data were analyzed using conventional content analysis.

FINDINGS

We generated nine categories representing informal caregivers' strategies grouped by resources used. Intrapersonal resources were used for: Flexibly adjusting to changing life situations; Separating the care recipient from the illness; and Reflectively renegotiating self-expectations. Interpersonal resources were used for: Coping together with the care recipient; Sharing responsibilities within the family; Seeking guidance from persons in similar situations; and Grouping social relations by function. Healthcare and community resources were used for: Active collaborations with healthcare staff and Accessing professional and community resources for mental well-being.

CONCLUSIONS

Informal caregivers used their intrapersonal, interpersonal, and healthcare and community resources in various ways for mainly emotional and instrumental support. More informational support from healthcare was desired, indicating that healthcare services, along with patient and caregiver organizations, may be able to enhance such support for informal caregivers. This could, in turn, allow more flexibility to manage caregiving alongside other life commitments.

Multicontextual Factors That Influence Work-Life Balance of Family Caregivers of Adults With Parkinson's Disease

OBJECTIVE

The purpose of study was to explore family caregiver perspectives on work-life balance while caring for adults with Parkinson's disease.

METHODS

The study was performed using a convergent mixed methods design and a revised adaptation of the Work-Life Conflict model. Caregivers completed surveys followed by semistructured interviews ( n = 40).

RESULTS

Work-life balance is bidirectionally influenced by time, stress, and behavior across the working and caregiving role. Caregiver burden was offset by higher decision latitude at work. Supervisor support and coworker support were positively associated with work-life balance. Barriers included physical, emotional, and financial stress, and speech and cognitive changes of the care recipient.

CONCLUSIONS

The results of this study identify the influence of work-life imbalance on caregiver burden and stress, and generate discussion of potential solutions that optimize well-being and health of this working population.

Mental and Physical Wellbeing of Carer-Employees in Canada

Today, an increasing number of Canadian adults are providing unpaid care to their family members and friends while working full or part-time. We conducted a national survey of unpaid caregiving for older people in 2022 to learn who these people are, why they care, and to identify the social, economic, and health impacts of unpaid caregiving. Our findings show that many of these caregivers are also employees. While most research shows that women caregivers and carer-employees experience work-care tension that results in negative mental and physical health outcomes, our results are more mixed. This paper provides descriptive findings of carer-employee's health and well-being, and compares them to previous research in Canada and abroad. I conclude with policy options for governments and employers to support the health and well-being of carer-employees.

Redefining caregiver strain for family caregivers in end-of-life care in Hong Kong

OBJECTIVES

Caregiving for family members at their end of life is stressful. Caregivers' strain, burden, or stress has been measured in various geographical and sociodemographic contexts. The concept of stress, burden, and strain are sometimes used interchangeably. By analysing the factor structure of the Chinese version of the Modified Caregiver Strain Index (C-M-CSI), this study aimed to examine the caregiving strain concept and its demographic correlates.

METHODS

A sample of 453 family caregivers of patients with a terminal illness in Hong Kong was employed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. In addition, generalized linear models (GLM) were used to examine the demographic correlates.

RESULTS

The EFA yielded a 3-factor model termed "Perception of Caregiving," "Empathetic Strain," and "Adjustment Demand." This 3-factor model explained 50% of the variance and showed good internal consistency. The CFA confirmed the 3-factor construct with satisfactory internal reliability (χ2 [61, N = 226] = 108.86, p < 0.001, CFI = 0.96, TLI = 0.95, SRMR = 0.04, and RMSEA = 0.06). Inspired by this factor structure and concepts of stress and strain from engineering discipline, a new model of caregiver strain is proposed. Additionally, family caregivers of non-cancer patients, who were not living with the patient, or younger were associated negatively with different dimensions of caregiver strain.

SIGNIFICANCE OF RESULTS

The results gave insights into the advancement of the conceptualization of caregiver strain, its multidimensional nature, and process of change, which inform directions for future research and practices.

Emotion Regulation, Coping Strategies, and Hazardous Drinking Among Family Caregivers of People With Alzheimer's Disease and Related Dementias

PURPOSE

The current study investigated hazardous drinking and alcohol use disorders among 453 family caregivers of individuals living with Alzheimer's disease and related dementias (ADRD).

METHOD

We examined the prevalence of hazardous drinking and its relationship with emotion regulation and coping strategies (problem-solving, social support, and avoidance) using data from the first wave of a longitudinal study on daily ADRD caregiving experiences. A binary logistic regression model was performed to predict the relationship between potential risk factors and hazardous drinking.

RESULTS

Findings revealed that 18.1% of ADRD caregivers screened positive for hazardous drinking based on the Alcohol Use Disorders Identification Test-Consumption. Caregivers experiencing greater difficulties in emotion regulation and greater reliance on avoidance as a coping strategy were at higher risk of screening positive for hazardous drinking.

CONCLUSION

These findings stress the importance of targeted interventions to improve emotion regulation and reduce avoidance coping in ADRD caregivers, ultimately enhancing their well-being. [Research in Gerontological Nursing, 17(2), 81-90.].

Moderating Effect of Work on Burden and Hospice Family Caregiver Well-Being

Background: Hospice family caregiving is often physically and emotionally taxing, but it is unclear how employment status impacts hospice caregiver burden and well-being. Objective(s): To examine the relationship between caregiver burden and well-being, and the moderating role of employment status (i.e., working, not working). Design, Setting/Subjects: This was a secondary data analysis of baseline data from a longitudinal observational study of family caregivers of home hospice cancer patients in the United States. Descriptive statistics, correlations, hierarchical linear regressions, and moderation analyses were used. Measurements: Baseline data included demographics, preparedness for caregiving, perceived burden, and well-being (i.e., global health, positive affect and well-being, anxiety, depression). Results: The majority of the 90 participants were White (86.7%), married (71.1%), and college educated (85.6%). The mean age was 58.27 ± 14.22, 53.3% cared for a spouse, and 56.6% worked full or part time. After controlling for demographics, and using employment status as a moderator, greater caregiver burden was significantly associated with lower global health (β = -0.82 [-1.22 to -0.42], p < 0.001), positive affect and well-being scores (β = -0.69 [-1.03 to -0.36], p < 0.001), and higher depression (β = 0.24 [0.12-0.37], p < 0.001) and anxiety scores (β = 0.22 [0.07-0.37], p < 0.005). Employment status significantly moderated the relationship between burden and global health (β = 0.65 [0.22 to 1.08], p < 0.005), and burden and positive affect and well-being (β = 0.45 [0.06 to 0.84], p < 0.05). At high levels of burden, workers had greater well-being than nonworkers. Conclusion(s): More burdened hospice caregivers may experience worse well-being, especially among nonworking caregivers. Employment may be a protective factor for highly burdened hospice family caregivers.

Development and validation of the caregiver needs and resources assessment

Introduction

Existing caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes.

Methods

Items of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA.

Results

The results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity.

Discussion

The CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.

Diverse demands and resources among racially/ethnically diverse caregivers

OBJECTIVES

The family caregiver population in the US is growing in conjunction with greater numbers of older adults with serious illness and complex care needs, and is becoming increasingly diverse. This study described and compared resources, demands, and health outcomes among diverse family caregivers by race/ethnicity.

DESIGN

This study was a cross-sectional secondary analysis of nationally representative data collected for Black/African-American, Asian American & Pacific Islander, Latino/Hispanic and non-Latino/Hispanic white caregivers (n = 2,010) in the Home Alone Revisited Study. We described available resources (e.g. income, paid help, social support) and demands (e.g. medical/nursing task performance) by racial/ethnic group. Using survey-weighted logistic regression, we examined relationships of resources and demands with caregiver outcomes (i.e. heath status; strain; depressive symptoms) by race-ethnicity controlling for socio-demographic variables.

RESULTS

Distribution of resources and demands was similar by race/ethnicity, except for higher income for non-Latino/Hispanic white caregivers. Nearly half assisted with personal care (47.5%) or medical/nursing tasks (49.7%). Higher social support and satisfaction with social relationships was associated with positive health outcomes regardless of race/ethnicity, while income was consistently associated with positive health outcomes only for non-Latino/Hispanic white caregivers. Medical/nursing task performance was significantly associated with negative health outcomes for Asian American & Pacific Islanders in multivariable models.

DISCUSSION

Many caregiving demands and tasks are similar by race/ethnicity and represent considerable investment of time, energy and care. Differences in the effects of resources and demands by race/ethnicity should be explored in future research as they may have implications for assessment and planning of culturally and linguistically appropriate interventions.

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

The vast majority of older adults who are chronically ill rely on informal caregivers for support. Caregivers often require additional support to facilitate their role. To the best of our knowledge, there has yet to be a collation of caregiver-identified priorities for support. Using existing research, this scoping review provides a comprehensive picture of what caregivers have indicated as priorities for support. Arksey and O'Malley's scoping review framework guides this review. We searched MEDLINE, CINAHL and PsycINFO databases on July 2, 2021. We selected databases based on their relevance to nursing, health and social science. Inclusion criteria were peer-reviewed research of any design, a sample population of caregivers to older adults (>55 years), manuscripts published in English and the priorities for caregiver support identified by caregivers themselves. We screened a total of 3591 records, and 33 articles met the inclusion criteria. These studies were from geographic settings across the globe and used various quantitative, qualitative and mixed-method study designs. In our synthesis, we quantified the identified priorities within the studies using coding and content analysis. We present the following list of caregiver-identified priorities: (1) orientation to the caregiving role; (2) self-care and respite; (3) adapting healthcare; (4) improved supports; (5) information needs; (6) access to resources; (7) financial assistance. Policymakers, healthcare professionals and non-profit organisations can use evidence from this review to guide decisions when developing support services and interventions for caregivers.

Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers

BACKGROUND AND OBJECTIVES

Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services.

RESEARCH DESIGN AND METHODS

The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services.

RESULTS

Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains.

DISCUSSION AND IMPLICATIONS

Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.

The relationships of job and family demands and job and family resources with family caregivers' strain

Background

Because of an expected increase in the number of family caregivers, there is a growing public and scientific interest in family caregiving and more specifically in the combination of family care with paid employment. It is important to gain insight in the family caregivers’ strain and determining factors in the job and family domain.

Aim

The aim of the study was to examine the associations of job and family demands and job and family resources with indicators of caregivers’ psychological strain, that is caregiver burden, work‐related emotional exhaustion and general ill mental health. In our research, we focused on individuals who combine paid employment with family caregiving.

Methods

A cross‐sectional design was used. The study sample was derived in 2011 from a Dutch financial organisation and a healthcare organisation. A digital fully structured questionnaire was used. The sample consisted of 187 employees who identified themselves as family caregivers. Descriptive statistics and hierarchical linear regression analysis were performed.

Results

Job demands (i.e. workload, work–family conflict) and family demands (i.e. family care hours and family–work conflict) were significantly positively associated with all three domain‐specific indicators of strain. The resources of work–family and family–work enrichment and autonomy did not contribute to less experienced strain. More supervisor and colleague support was associated with lower ill mental health.

Conclusion

Our study showed that job demands (workload, work–family conflict) and family demands (family care hours, family–work conflict) were clearly associated with caregiver strain, while associations for job and family resources were not evident. It remains necessary to pay attention to the demanding aspects of dual roles of family caregivers but also to investigate the resources they have available at work as well as in their home situation and explore their potential reducing effect on family caregivers’ strain.