Informal caregiver support needs and burden: a survey in Lithuania

Capturing Potential Interventions for the Empowerment of Older People and Informal Caregivers in Transitional Care Decision-Making: A Qualitative Study Using Focus Groups

AIM

To capture older people's, informal caregivers' and health professionals' ideas on potential interventions for empowering older people and informal caregivers in transitional care decision-making.

DESIGN

A descriptive qualitative design was adopted.

METHODS

The study was conducted between February and May 2022 in the region of Flanders, Belgium, as part of the TRANS-SENIOR consortium's collaborative research. Data were collected using focus groups, including older people, informal caregivers and healthcare professionals involved in any physical relocation of the older person across home, hospital or nursing home settings. Thematic data analysis was performed based on Braun and Clarke's six-step method.

RESULTS

A total of 40 people participated in the focus groups. Four main themes were identified, which describe ideas on how to empower older people and informal caregivers in transitional care: Providing clear and timely information, preparing people for what is to come, person-centredness and providing professional and peer support for informal caregivers.

CONCLUSIONS

Healthcare (professionals) should facilitate older people's and informal caregivers' empowerment in transitional care decision-making by setting them at the core and inception of the decision-making process. While informal caregivers support their loved ones in decision-making processes, they should also be supported and monitored for burdensome issues.

IMPLICATIONS TO PATIENT CARE

Multicomponent, well-planned and personalised interventions are needed to empower older people and informal caregivers in transitional care decision-making. The ideas raised by all stakeholders who participated in this study can inform these interventions.

REPORTING METHOD

Adhered to consolidated criteria for reporting qualitative research checklist.

PATIENT OR PUBLIC CONTRIBUTION

Organisations advocating for the interests of older people and informal caregivers played a pivotal role in shaping the TRANS SENIOR project. Furthermore, the study benefitted from the collaborative input of AGE Platform Europe, which amplified the voices and representation of older people during the project design phase.

Mandarin Chinese Translation and Cultural Adaptation of the Caregiver Analysis of Reported Experiences With Swallowing Disorders Screening Tool

PURPOSE

The caregiver burden of individuals with dysphagia is a major concern. Currently, assessment tools specifically designed for this population are lacking. The present study aimed to translate the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Questionnaire into Mandarin Chinese and evaluate its psychometric properties.

METHOD

This study analyzed the psychometric properties of the Mandarin Chinese version of the CARES questionnaire using classical measurement theory and Rasch model analysis.

RESULTS

Classical measurement theory: The item-level content validity index of the Mandarin Chinese version of the CARES questionnaire ranged from .83 to 1.00, and the scale-level content validity index ranged from .93 to .95. The correlation coefficient between the total scores, subscale scores of the CARES questionnaire, and Zarit Caregiver Burden Interview scores was between .82 and .87 (p < .01). There were significant relationships between dysphagia-specific burden (CARES) and perceived swallowing impairment (Eating Assessment Tool-10) and diet restrictiveness (International Dysphagia Diet Standardisation Initiative Functional Diet Scale). The overall Cronbach's α coefficient of the Mandarin Chinese version of the CARES questionnaire was .81. Item response theory: The Mandarin Chinese version of the CARES questionnaire was unidimensional. The item difficulty and individual ability were evenly distributed. The total item reliability was .96, the person reliability was .79, the item separation index was 4.95, and the person separation index was 1.93.

CONCLUSION

The Mandarin Chinese version of the CARES questionnaire demonstrates satisfactory reliability and validity and can be utilized as a specific assessment tool for evaluating the informal caregiver burden of individuals with dysphagia.

Caregiver burden, psychological well-being, and support needs among Swedish informal caregivers

The proportion of elderly people in the world is increasing, which increases the burden on the healthcare system and requires more formal and informal care. In Europe, informal care accounts for approximately 3.5% of GDP, and this is expected to increase. In Sweden, about 1.3 million people are informal caregivers (900,000 of whom are employed). Informal care is most common among people aged 45-65 years. Informal caregivers suffer from mental and physical health problems, such as depression, anxiety, and cardiovascular issues. The aim of this study was to describe informal caregivers in Sweden, their caregiver burden, psychological well-being, and their support needs. A web survey was used to collect data, and 379 informal caregivers responded to the survey. The results of this study showed that the majority of informal caregivers are women with good economic status and university education. Most care for one person, usually a spouse or a child, and balance work with caregiving tasks. Informal caregivers who provided care, help, and support to one person experienced greater burdens and higher levels of stress and depression. The impact on burden and psychological well-being becomes more pronounced when the informal caregiver has a close relationship or lives in the same household as the care recipient. These findings, and the fact that 82% of the participants use digital tools daily and are open to receiving support digitally, underscore the urgent need for digital interventions to reduce the caregiver burden and improve the psychological well-being of informal caregivers.

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

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

Assessment of Competencies and Ability to Care for the General Population: Design and Validation of the Spanish COMCAPCARE Scale

BACKGROUND

As the population ages, the demand for social and health systems grows, especially due to chronic diseases and dependency. Informal caregivers, particularly women, face significant burdens including physical, emotional, and financial strain. Current caregiving assessment tools focus on those already in caregiving roles or health professionals, with no tools for the general population without prior caregiving experience.

PURPOSE

This study aimed to develop and validate the Spanish COMCAPCARE scale, which assesses the skills and abilities necessary to care for dependent individuals, including those nearing the end of life, among individuals without prior caregiving experience.

METHODS

A scale validation study was conducted. A Delphi panel of 13 experts developed an 18-item scale, which was administered to 253 participants over the age of 18 who had not previously served as primary caregivers. Main measurements were psychometric analyses, including principal components analysis (PCA) and reliability testing using Cronbach's alpha and intraclass correlation coefficient. Correlation with a single-item self-assessment of caregiving competence was verified through Spearman's rho.

RESULTS

A total of 253 participants (73.9% women) with a mean age of 33 years (SD 13.7) participated. The scale identified 3 factors: financial and work situation (4 items), adaptability (8 items), and care and communication (6 items). The total scale demonstrated high reliability (α = 0.84) and significant correlations between the scale's total score and a single-item self-assessment of caregiving competence (r = 0.693, P < .001).

CONCLUSIONS

The Spanish COMCAPCARE scale provides a reliable and valid tool for assessing caregiving competencies in the general population without caregiving experience.

Needs of Family Caregivers of People with Lower Limb Amputations: A Scoping Review

Lower limb amputation affects several parameters of a patient's life. Family caregivers providing care for these patients experience multiple feelings and needs; knowing caregivers' needs is essential to prepare them for this new role, as well as the health planning of this type of care. This scoping review aimed to identify and map the needs of family caregivers of people with lower limb amputations. This scoping review was conducted in accordance with the JBI methodological framework and the PRISMA-ScR reporting guidelines. A bibliographical search was carried out on the needs of family caregivers of lower limb amputees in 15 databases. Two independent reviewers extracted data using a data extraction tool developed for this scoping review. Eight studies were included in the present review (n = 6 quantitative studies; n = 2 reviews). Results indicate that family caregivers of people with lower limb amputations may experience an extensive range of needs, as follows: (i) mental health and psychological support, (ii) physical health, (iii) health and well-being, (iv) supportive care, (v) social support, and (vi) educational/informational support. The needs identified in this review can help to develop interventions and programs that provide better support during the situational transition process.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana

BACKGROUND

Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among  informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship  between caregiver burden and HRQoL among informal caregivers of older adults in Ghana.

METHODS

We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of  0.05 or less.

RESULTS

The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (β = -1.204, SE= .4085, p value = 0.01), those with primary level of education (β = -2.390, SE= .5099, p value = 0.001) or junior high school education (β = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (β = 2.960, SE= .6306, p value=0.001), 25-34 (β = 1.728, SE= .5794, p value = 0.01) or 35-44 (β = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (β = 4.786, SE=. 4610, p value= 0.001).

CONCLUSION

Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially  support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among  informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

Perceptions of Stress and Engagement in High-Intensity Caregiving: A Cross-Sectional Study in Lithuania

The aging population and overstretched healthcare systems are increasing demand for home nursing by informal caregivers, significantly affecting their mental health. This study aimed to examine the level of population's engagement in caregiving and the association between high-intensity caregiving and perceived caregiving stress in the general population of Lithuania. A nationally representative sample (N = 1000) of Lithuanian residents aged 18 years and older (mean age 53.1 ± 17.9 years) was interviewed in their households. The results showed that 17.4% (95% CI: 15.1, 19.8) of respondents were involved in home nursing activities to some extent, with 42% of these being high-intensity caregivers (providing 11 or more hours of home care per week). Caregivers were statistically significantly more likely to be female and have higher education levels. Perceived stress was significantly associated with higher education levels (OR = 2.66, 95% CI: 1.41, 5.02), high-intensity caregiving (OR = 2.14, 95% CI: 1.15, 3.97), regular involvement in home nursing (OR = 1.86, 95% CI: 1.01, 3.43), and caring for recipients with dementia or individuals entirely dependent on assistance (OR = 2.52, 95% CI: 1.22, 5.23). Caregivers perceived stress is associated with their level of education, the intensity and regularity of home nursing, as well as the level of dependency of the care recipient, especially in cases of dementia. Comprehensive long-term care policies should be developed to ensure the larger availability of formal care resources, increased societal participation in home nursing, and tailored interventions for high intensity caregivers.

Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model

BACKGROUND

Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps.

OBJECTIVE

This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps.

METHODS

The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app.

RESULTS

Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding "facilitating conditions" and "verbal encouragement" as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden.

CONCLUSIONS

This study revealed important immigrant informal caregivers' needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving.

Role and perspectives of informal care: a qualitative study of informal caregivers in the Republic of Croatia

OBJECTIVES

Population ageing and the prevalence of multimorbidity represent major challenges for healthcare systems. People who need long-term care have complex conditions requiring both health and social services. Informal caregivers are emerging as an important part of the long-term care ecosystem. This paper aims to explore the position and capacities of informal caregivers in Croatia.

DESIGN

Health and social care legislative documents were analysed using a structured set of keywords. In addition, focus groups were conducted with informal caregivers who cared for a family member. The qualitative method of thematic analysis was used.

SETTING AND PARTICIPANTS

Two focus groups were conducted with 15 caregivers (13 women and 2 men). Geographically, participants came from all four NUTS2 Croatian regions. All participants cared for a close family member. The length of care provision ranged from 3 to 35 years. Focus groups were conducted using the Zoom platform.

RESULTS

The analysis of the documents indicates the fragmentation of national policy into health and social policy. Long-term care as a term is recognised only in health policy. However, some components related to long-term care are part of social policy. Caregivers are recognised in social policy, although not in healthcare. In focus groups, three main themes were identified as follows: (1) position and role of the caregivers in the system and society; (2) types of care based on the recipient's need and (3) support for the caregivers.

CONCLUSION

The research showed that the process of exercising certain rights and services for caregivers is not sufficiently clear and feasible in practice. There is a lack of a clearly defined role of caregivers and relationships towards professional care providers in the system. The key to improving long-term care is connecting community services, including health and social services, both formal and informal, with the process of providing care.

"Why take the patient back home?": Exploring the lived experiences of caregivers of COVID-19-infected individuals in Blantyre, Malawi

The Corona Virus Disease 2019 (COVID-19) pandemic continues to have serious health and socio-economic consequences. In Malawi, COVID-19 cases are managed at home, with hospital admission reserved for severe cases. This study described the lived experiences of caregivers of COVID-19-infected individuals in Blantyre, Malawi. This descriptive qualitative study was conducted from January to June 2021 in Blantyre, Malawi, among caregivers of confirmed SARS-COV-2 cases enrolled in the SARS-CoV-2 study and aimed to explore infections, transmission dynamics, and household impact. We conducted 37 in-depth interviews with caregivers of SARS-COV-2 cases who were purposively sampled. We captured data using telephonic interviews, digitally recorded, transcribed verbatim, managed using NVivo, and analysed it using a thematic approach guided by the theory of caregiving dynamics. Caregivers stated that the economic status of a family largely influenced caregiving roles and abilities because it determined the resources that a household could access or not. Caregivers expressed being committed to their role despite being ill-prepared to manage a COVID-19 patient at home, in addition to fears about the contagious nature of COVID-19. They prioritised their patients' health by ensuring that they were present to offer nutritional and medical treatment. Caregivers highlighted challenges faced in the implementation of preventive measures because of financial limitations and cultural factors. They further expressed fear resulting from the increase in death rates, and the lack of proper information challenged their expectation of having their patients healed. Caregivers stated that they managed their role by sharing responsibilities, getting better at it with time, and getting support from religious institutions and social networks. Caring for confirmed cases of COVID-19 demanded commitment from the caregivers while ensuring that the transmission of the virus was minimised. There is a need to support households in isolation with the right information on how to manage their patients and streamline social support for the ultra-poor.

Correlates of Physical and Emotional Strain Among Older Adult Caregivers

Caregiving can be physically challenging and emotionally draining for older caregivers. The existing research on physical and emotional strain mainly focuses on the general caregiver population. Using the Stress Process Model, this study aims to expand on existing caregiving literature by identifying correlates of physical and emotional strain among older caregivers. Hierarchical OLS regressions were performed on data selected from the 2015 Caregiving in the U.S. Survey (N = 701). Several risk factors for physical strain and emotional strain were identified: Assistance with ADLs and IADLs, the number of health problems of the care recipient, and the receipt of formal support were positively associated with physical and emotional strain. Moreover, providing care to parents/parents-in-law was associated with higher levels of emotional strain than providing care to non-relatives. The number of care recipients was positively associated with emotional strain. Older African Americans experienced lower levels of physical strain than their white counterparts. The findings uncover the individual differences among older caregivers and provide insights into how these differences uniquely influence caregiving strain. Moreover, the study identifies a risk and protective profile of caregiving strain, which can help practitioners direct services and resources to older caregivers who are particularly at risk for caregiving strain.

Cognitive behavioural therapy self-help intervention preferences among informal caregivers of adults with chronic kidney disease: an online cross-sectional survey

BACKGROUND

Informal caregivers (i.e. family and friends) provide essential support to people with chronic kidney disease (CKD). Many informal caregivers experience mental health problems such as anxiety and depression due to the caregiving role, and commonly have unmet psychological support needs. One potential solution is cognitive behavioural therapy (CBT) self-help interventions that are less reliant on extensive involvement of healthcare professionals, which may increase access. Within the intervention development phase of the MRC framework, the study's primary objective was to examine informal caregivers' self-help intervention preferences (e.g. delivery format, content). Secondary objectives were to describe the informal caregiver's situation (e.g. type of care activities) and mental health (symptoms of depression, anxiety, and stress).

METHODS

An online cross-sectional survey conducted in the United Kingdom. Informal caregivers of adults living with CKD were recruited via social media, websites, newsletters, magazine articles, a podcast episode, and paid Facebook advertisements. The survey examined: informal caregiver characteristics; care recipient characteristics; self-help intervention preferences; and informal caregiver's mental health using the DASS-21. Data were analysed using descriptive statistics.

RESULTS

Sixty-five informal caregivers participated. The majority (85%) were female, caring for a male (77%) spouse/partner (74%). Responses indicated 58% of informal caregivers were experiencing at least mild depression. In total, 48% indicated they were likely to use a CBT self-help intervention, preferring an intervention provided via internet (e.g. website) (64%), workbook (56%), or individually in-person (54%). Regarding content, interventions should cover a wide range of topics including living with CKD, support services, informal caregiver's physical health, and diet. Overall, 48% reported a preference for a supported intervention, with support delivered in-person or via email by a trained professional at a community organisation.

CONCLUSIONS

Results suggest CBT self-help interventions may be an acceptable way to provide psychological support to informal caregivers, however the study is limited by the small sample size. A wide range of intervention preferences were identified indicating a need to tailor intervention content and delivery to enhance acceptability and engagement. Results will inform development of a CBT self-help intervention for informal caregivers of people with CKD.

Design suggestions for a persuasive e-coaching application: A study on informal caregivers' needs

Objective

Informal caregivers such as relatives or close friends of patients are essential for caregiving at home. However, caregiving is a complex experience that may affect the caregivers' well-being. Therefore, there is a need to provide support for caregivers, which we address in this article by proposing design suggestions for an e-coaching application. This study identifies the unmet needs of caregivers in Sweden and provides design suggestions for an e-coaching application using the persuasive system design (PSD) model. The PSD model offers a systematic approach to designing IT interventions.

Methods

A qualitative research design was used, and semi-structured interviews were conducted with 13 informal caregivers from different municipalities in Sweden. A thematic analysis was performed to analyze the data. The PSD model was used to map the needs emerging from this analysis to propose design suggestions for an e-coaching application for caregivers.

Results

Six needs were identified, and based on them, we proposed design suggestions for an e-coaching application using the PSD model. These unmet needs are monitoring and guidance, assistance to avail formal care services, access to practical information without being overwhelmed, feeling of community, access to informal support, and grief acceptance. The last two needs could not be mapped using the existing PSD model, resulting in an extended PSD model.

Conclusion

This study revealed the important needs of informal caregivers based on which design suggestions for an e-coaching application were presented. We also proposed an adapted PSD model. This adapted PSD model can be further used for designing digital interventions in caregiving.

Caregiving Situation as a Predictor of Subjective Caregiver Burden: Informal Caregivers of Older Adults during the COVID-19 Pandemic

The COVID-19 pandemic has created and exacerbated emotional, financial, and technical challenges for informal caregivers of older people. The aim of this study was to explore the caregiving situation and subjective burden of informal caregivers of older family members during COVID-19, and to investigate how a caregiving situation's characteristics predict the subjective burden of care in times of COVID-19. The study was conducted in April and May 2021 via an online access panel. The sample (n = 612) was determined using a screening test that enabled us to focus on a Slovenian population of informal caregivers aged 40+ caring for a person aged 65+ for at least four hours/week on average. Our findings reveal that the subjective burden of care was high among informal caregivers during COVID-19. Multiple regression analysis showed that the provision of activities of daily living, care duration, average hours of care per week, formal care status, and recipients' health problems related to dementia or other memory problems significantly predicted the subjective burden of caregivers. These findings call for better recognition of the role of informal caregivers. The time and effort devoted to informal care should be supported by legislation and social security.