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Cham CQ, Ibrahim N, Siau CS, Kalaman CR, Ho MC, Yahya AN, Visvalingam U, Roslan S, Abd Rahman FN, Lee KW. Caregiver Burden among Caregivers of Patients with Mental Illness: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10122423. [PMID: 36553947 PMCID: PMC9777672 DOI: 10.3390/healthcare10122423] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
Due to the increasing importance of caregivers in the treatment outcomes of patients with mental illness, this study aimed to systematically review studies investigating the former's caregiver burden and determine its prevalence. An open search, without filters, was conducted. Articles were selected from Medline, Scopus, and PubMed from inception to 30 April 2022 using the PRISMA protocol. Subgroup analyses examined the between-group differences by study setting, measurements used, and disorder type. A total of 5034 caregivers from 23 countries were included in this review. Thirty-nine studies were included in the systematic review, and, among them, twenty-six were deemed eligible for meta-analysis. The overall pooled prevalence of caregiver burden among caregivers of individuals with mental illness was 31.67% (95% CI = 26.22-37.12). Pooled prevalence was the highest among care recipients receiving treatment in a hospital setting (36.06%; 95% CI = 22.50-49.63), followed by the community and clinic settings. Caregiver prevalence values were higher for burden measured using the Zarit Burden Interview (38.05%; 95% CI = 27.68-48.43). compared with other instruments, and for carers of care recipients with psychosis (35.88%; 95% CI = 27.03-44.72) compared with those without. Thus, targeted interventions should focus on caregivers of patients in hospital settings and with psychotic symptoms.
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Affiliation(s)
- Choy Qing Cham
- Center for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (C.Q.C.); (C.R.K.)
| | - Norhayati Ibrahim
- Center for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (C.Q.C.); (C.R.K.)
- Institute of Islam Hadhari, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
- Correspondence:
| | - Ching Sin Siau
- Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
| | - Clarisse Roswini Kalaman
- Center for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (C.Q.C.); (C.R.K.)
| | - Meng Chuan Ho
- Centre for Pre-U Studies, UCSI University (Springhill Campus), Port Dickson 71010, Malaysia;
| | - Amira Najiha Yahya
- Department of Educational Psychology & Counselling, Faculty of Education, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | - Uma Visvalingam
- Department of Psychiatry, Hospital Putrajaya, Putrajaya 62250, Malaysia;
| | - Samsilah Roslan
- Department of Foundation of Education, Faculty of Educational Studies, Universiti Putra Malaysia, Serdang 43400, Malaysia;
| | - Fairuz Nazri Abd Rahman
- Psychiatry Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
| | - Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia;
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Dementia caregiving across Latin America and the Caribbean and brain health diplomacy. LANCET HEALTHY LONGEVITY 2021; 2:e222-e231. [PMID: 34790905 PMCID: PMC8594860 DOI: 10.1016/s2666-7568(21)00031-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.
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Testoni I, Sicari G, Ronconi L, Biancalani G, Franco C, Cottone P, Crupi R. Dehumanization and burden of care among caregivers of terminally ill patients. Health Psychol Res 2021; 9:29052. [DOI: 10.52965/001c.29052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova; Emili Sagol Creative Arts Therapies Research Center, University of Haifa
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Martínez-Santos AE, Facal D, Vicho de la Fuente N, Vilanova-Trillo L, Gandoy-Crego M, Rodríguez-González R. Gender impact of caring on the health of caregivers of persons with dementia. PATIENT EDUCATION AND COUNSELING 2021; 104:2165-2169. [PMID: 33610335 DOI: 10.1016/j.pec.2021.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dementia is a brain syndrome that affects a growing number of persons worldwide and generates a strong and progressive demand for care from a family caregiver, usually females. OBJECTIVE We aimed to describe the care provided by family caregivers of persons with dementia as well as the impact on their health and its interrelation with gender. PATIENT INVOLVEMENT This study was carried out in collaboration with the 13 associations of family caregivers of persons with dementia that are part of a Regional Federation. This partnership worked towards bettering patient care and proposing improvements to the public health system. METHODS A multi-institutional cross-sectional study. A total of 462 primary family caregivers of persons with dementia from north-west Spain were included. Data were collected between January and April 2019 with an anonymous self-administered validated questionnaire (ICUB-97) based on Virginia Henderson's nursing care model. RESULTS The most affected needs in family caregivers are those related to "recreational activities", "communication" and "rest and sleep". Statistically significant differences between male and female participants' pattern of care and health-related impacts were found, especially in issues related to work and family reconciliation. DISCUSSION Care plans should be developed taking gender perspective into account. From a nurse model point of view, more research is necessary to reduce health disparities. This study provides an assessment of gender differences in care and the impact on caregivers' health. PRACTICAL VALUE Regarding the specific health conditions of female caregivers and from a holistic point of view, these findings could provide novel and interesting data that might help to implement gender perspective in nursing care plans, generally invisible in routine clinical practice.
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Affiliation(s)
- Alba-Elena Martínez-Santos
- University of Santiago De Compostela, Faculty of Education Sciences, Department of Pedagogy and Didactics, Santiago de Compostela, Spain; University of Santiago De Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain
| | - David Facal
- University of Santiago De Compostela, Faculty of Psychology, Department of Developmental Psychology, Santiago de Compostela, Spain
| | | | | | - Manuel Gandoy-Crego
- University of Santiago De Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain
| | - Raquel Rodríguez-González
- University of Santiago De Compostela, Faculty of Nursing, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Santiago de Compostela, Spain; Health Research Institute of Santiago De Compostela (IDIS), Santiago de Compostela, Spain.
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Williams A, Lyeo JS, Geffros S, Mouriopoulos A. The integration of sex and gender considerations in health policymaking: a scoping review. Int J Equity Health 2021; 20:69. [PMID: 33653362 PMCID: PMC7923641 DOI: 10.1186/s12939-021-01411-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
While the terms 'sex' and 'gender' represent distinct concepts, their influence may intersect as important determinants of health. Despite their influence in shaping individual health outcomes, there is often inaccuracy and inconsistency in the degree to which sex and gender considerations are integrated in the health policymaking process. This primary aim of this paper is to fill the gap in the current understanding of how sex and gender considerations are integrated in this process. A scoping review methodology was used with the objective of assessing the extent to which sex and gender were considered inclusively and comprehensively in established examples of health policy planning and development. One hundred seventy-five documents from the academic and grey literature were found to meet the inclusion criteria for this scoping review. The authors charted the data from these publications, assessing the ways in which sex and gender were incorporated in their policy development process. Five key findings were ascertained from this review: (1) the terms sex and gender are often used interchangeably; (2) the terms sex and gender are often used with a limited and binary scope; (3) the most inclusive and comprehensive documents included transgender and gender diverse populations; (4) there are significant variations in the degree of inclusivity and comprehensivity of these documents based on geographic distribution; and (5) documents published within the last 5 years were more inclusive than older documents. This paper concludes with an acknowledgment of the limitations of the study design, a summary of the findings, future research directions, and implications for policymakers.
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Acknowledging cancer as a family disease: A systematic review of family care in the cancer setting. Eur J Oncol Nurs 2020; 49:101841. [DOI: 10.1016/j.ejon.2020.101841] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
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Muthukaruppan SS, Cameron C, Campbell Z, Krishna D, Moineddin R, Bharathwaj A, Poomariappan BM, Mariappan S, Boychuk N, Ponnusamy R, MacLachlan J, Brien M, Nixon S, Srinivasan SR. Impact of a family-centred early intervention programme in South India on caregivers of children with developmental delays. Disabil Rehabil 2020; 44:2410-2419. [PMID: 33103498 DOI: 10.1080/09638288.2020.1836046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study evaluated the impact on caregiver strain and family empowerment among caregivers of children with disabilities who received training and education as part of a family-centred community-based early intervention programme in South India. METHODS This prospective open cohort longitudinal study compared change from baseline to two years post-intervention among caregivers of the first cohort of children who were enrolled in the programme. Paired t-tests determined effect on the Modified Caregiver Strain Index (MCSI) and Family Empowerment Scale (FES), and p-values were adjusted for multiple comparisons using the False Discovery Rate approach. RESULTS Of the 308 caregivers (91% women), 44% provided care to children with cerebral palsy and 56% to children with other developmental delays. The mean age of the children at baseline was 3.3 (±1.5 years). The overall mean change from baseline in the FES was 4.1 (95% CI: 3.3, 4.9; p < 0.001) representing improved empowerment. The mean change for the MCSI score was -3.7 (95% CI: -4.5, -2.9; p < 0.001) representing reduced caregiver strain. CONCLUSIONS A family-centred early intervention programme that provides training and education to caregivers of children with developmental delays demonstrated positive change in caregiver strain and family empowerment.Implications for RehabilitationThe well-being of a child is influenced by the well-being of their caregiver.Improving caregiver well-being can help improve care and support for children with developmental delays.A family-centred early intervention therapy programme that includes training and education to caregivers can reduce strain and improve family empowerment.
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Affiliation(s)
| | - Cathy Cameron
- International Centre for Disability and Rehabilitation, Toronto, Canada
| | | | - Dinesh Krishna
- Amar Seva Sangam, Ayikudy, India.,International Centre for Disability and Rehabilitation, Toronto, Canada.,Handi-Care International, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | | | | | - Natalie Boychuk
- International Centre for Disability and Rehabilitation, Toronto, Canada
| | | | - Janna MacLachlan
- International Centre for Disability and Rehabilitation, Toronto, Canada.,Handi-Care International, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Stephanie Nixon
- International Centre for Disability and Rehabilitation, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Sex and gender differences in caregiving burden experienced by family caregivers of persons with dementia: A systematic review. PLoS One 2020; 15:e0231848. [PMID: 32310969 PMCID: PMC7170244 DOI: 10.1371/journal.pone.0231848] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/01/2020] [Indexed: 01/29/2023] Open
Abstract
Objectives Much is known about the demands of caregiving for persons with dementia (PWD) and its effects on family caregivers, however sex and gender aspects have received less attention. We synthesized the evidence on sex and gender distinctions in: (1) the caregiving burden and (2) the impact of caregiving on the physical and mental health of family caregivers of PWD. Design Systematic review. Data sources Medline, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature between January 2007 and October 2019 were searched. Eligibility criteria for selecting studies Included studies met the following criteria: (1) examine experiences and/or impacts of caregiving among family caregivers of individuals with any form of dementia; (2) report sex and/or gender distribution of study population and/or report results stratified by sex and/or gender, and (3) include both male and female family caregivers. Data extraction and synthesis Two independent reviewers extracted the data and assessed risk of bias using the Critical Appraisal Skills Program checklist and National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. Data were synthesized using a narrative synthesis approach. Results A total of 22 studies were included. Caregiving burden was measured using various methods. A majority of studies reported higher burden among females. All studies that did not report a sex and gender difference in caregiving burden accounted for confounders. Findings on sex and gender differences on physical and mental health conditions were inconsistent with most studies failing to account for confounders in their analyses. Conclusions Current evidence on sex and gender differences in caregiving burden, mental and physical health is limited. Findings suggest presence of sex and gender differences in caregiving burden. Given the variety of mental and physical health constructs that were examined, further research is required to substantiate the evidence. PROPSERO Registration Number: CRD 42018070032.
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Vick JB, Ornstein KA, Szanton SL, Dy SM, Wolff JL. Does Caregiving Strain Increase as Patients With and Without Dementia Approach the End of Life? J Pain Symptom Manage 2019; 57:199-208.e2. [PMID: 30453054 PMCID: PMC6348024 DOI: 10.1016/j.jpainsymman.2018.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
Abstract
CONTEXT Family caregivers play critical and demanding roles in the care of persons with dementia through the end of life. OBJECTIVES The objective of this study was to determine whether caregiving strain increases for dementia caregivers as older adults approach the end of life, and secondarily, whether this association differs for nondementia caregivers. METHODS Participants included a nationally representative sample of community-living older adults receiving help with self-care or indoor mobility and their primary caregivers (3422 dyads). Older adults' death within 12 months of survey was assessed from linked Medicare enrollment files. Multivariable logistic regression was used to assess the association between dementia and end-of-life status and a composite measure of caregiving strain (range: 0-9, using a cut point of 5 to define "high" strain) after comprehensively adjusting for other older adult and caregiver factors. RESULTS The prevalence of dementia in our sample was 30.1%; 13.2% of the sample died within 12 months. The proportion of caregivers who experienced high strain ranged from a low of 13.5% among nondementia, non-end-of-life caregivers to a high of 35.0% among dementia caregivers of older adults who died within 12 months. Among dementia caregivers, the odds of high caregiving strain were nearly twice as high (aOR = 1.94, 95% CI: 1.10-3.45) for those who were assisting older adults nearing end of life. Among nondementia caregivers, providing care near the end of life was not associated with high strain. CONCLUSION Increased strain toward the end of life is particularly notable for dementia caregivers. Interventions are needed to address the needs of this population.
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Affiliation(s)
- Judith B Vick
- Johns Hopkins University School of Medicine, Edward D. Miller Research Building, Baltimore, Maryland, USA.
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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