Resilience in family caregivers of Asian older people with dementia: An integrative review

AIM

To identify factors associated with resilience in family caregivers of Asian older people with dementia based on Luthar and Cicchetti's definition of resilience.

DESIGN

Integrative review of resilience in family caregivers of Asian older people with dementia reported by studies with quantitative and qualitative research designs.

DATA SOURCES

Databases used for the literature search included CINAHL, PubMed, EMBASE, PsycINFO and Google Scholar.

REVIEW METHODS

A total of 565 potentially relevant studies published between January 1985 and March 2024 were screened, and 27 articles met the inclusion criteria.

RESULTS

Family caregivers were most commonly adult children of care recipients, female and providing care in their home. Two themes emerged from the review: factors associated with adversity (dementia severity, caregiver role strain, stigma, family stress, female gender, low income and low education) and factors associated with positive adaptational outcomes (positive aspect of caregiving, social support and religiosity/spirituality).

CONCLUSION

In our review of Asian research, four new factors-caregiver role strain, stigma, family stress and positive aspects of caregiving-emerged alongside those previously identified in Western studies. A paradigm shift was observed from a focus on factors associated with adversity to factors associated with positive adaptational outcomes, particularly after the issuance of the WHO's 2017 global action plan for dementia. However, a gap remains between WHO policy recommendations and actual research, with studies often neglecting to address gender and socioeconomic factors.

IMPACT

The review findings will broaden healthcare providers' understanding of resilience in dementia caregivers and use them to develop comprehensive programmes aimed at reducing factors associated with adversity and enhancing those associated with positive adaptational outcomes. This approach can be customized to incorporate Asian cultural values, empowering caregivers to navigate challenges more effectively.

NO PATIENT OR PUBLIC CONTRIBUTION

This paper is an integrative review and does not include patient or public contributions.

Who do patients depend on as they age and for what medical needs? An exploratory study of Chinese and Latino primary care patients

BACKGROUND

As the U.S. population ages, family members increasingly act as informal caregivers, particularly for minority patients and those with limited English proficiency (LEP). However, physicians often do not identify or engage caregivers until there is a health crisis. This study aims to further our understanding of characteristics associated with having a caregiver present at a primary care visit, and better understand the specific roles family caregivers engage in to support older Chinese and Latino primary care patients.

METHODS

Primary care patients were surveyed by telephone in a study of language access and communication. Participants included Chinese and Latino primary care patients (≥ 65 years old) from an academic general medicine practice. We asked patients if anyone was in the room with them during their most recent primary care visit (yes = caregiver accompanied). We asked about caregiving support for various needs, and examined associations of patient and visit characteristics with being accompanied, and frequency of caregiver support roles overall and by caregiver accompaniment.

RESULTS

Among 906 participants, 80% preferred a non-English language, 64% were women, 88% had Medicare, and mean age was 76 years (range 65-97). 43% were accompanied to their most recent visit. Speaking English 'not at all' vs. 'very well' was associated with being caregiver accompanied (OR 3.5; 95% CI 1.3-9.7), as was older age ≥ 75 vs. 65-74 (OR 2.7; 95% CI 2.0-3.7). The most common roles being supported by caregivers included: transportation to medical appointments (63%), helping with medical decisions (60%), and talking with the doctor about the patient's medical care (54%). Even among unaccompanied patients, substantial proportions reported caregiver support with medical decisions (45%), talking with the doctor (33%), and medical needs at home (26%).

CONCLUSIONS

Opportunities for physicians to engage caregivers who have active support roles may be missed, especially if those caregivers are not present at the visit. Future interventions should aim to help physicians identify which patients have caregivers and for what needs, so they may effectively engage caregivers before a health crisis occurs.

How adult children experience and cope with their parents' diagnosis of multiple myeloma: A qualitative exploration

PURPOSE

The aim of this study was to understand and explore the caregiving experience of adult children of patients with multiple myeloma (MM) during diagnosis and initial treatment based in Chinese filial piety culture.

METHODS

A descriptive phenomenology study was conducted to investigate semi-structured interview responses from the adult children (N = 22) of MM patients within three months after diagnosis. Colaizzi's descriptive analysis framework was employed to analyze data. This study was reported following the COREQ checklist.

RESULTS

Four themes and twelve subthemes were identified from the interviews. (1) Commitment to filial piety. Participants subconsciously fulfilled their commitment to filial piety by supporting their parents, obeying their wishes, providing emotional comfort, and protecting them from harm. (2) Experiencing multiple dilemmas. They faced challenges such as difficult treatment decisions, insufficient caregiving preparation, emotional distress, and role conflict. (3) Benefiting from setbacks. The caregiving experience allowed participants to cherish the present more and to establish a new view of life. (4) Adaptive coping. Family supports and self-adaptation are effective coping strategies to achieve their good psychosocial adaptation.

CONCLUSIONS

Our study provides a culturally sensitive perspective on the caregiving experience of adult children of patients with MM. This study found that Chinese culture, especially filial piety culture, influenced the experiences and coping strategies of MM caregivers. Healthcare providers should focus on the challenges faced by adult children and develop various strategies to help them cushion the burden and adjust to caregiving roles, such as supportive care programs, meaning-centered psychotherapy, and family-centered medical communication interventions.

Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis

Background

Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.

Methods

Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI.

Results

Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.

Conclusion

The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Queens of hearts: Exploring the lived experiences of mothers caring for infants with complex congenital heart disease in Sri Lanka

This qualitative study explored the lived experiences of eight Sri Lankan mothers of infants with complex congenital heart disease (CCHD) using semi-structured interviews. Four themes were generated as: illness perception, communication with medical staff, challenges faced, and coping mechanisms. These provided insight into the multi-faceted nature of mothers' experiences, importance of medical-caregiver communications and their need for psychosocial services. The findings enhance the limited knowledge of South-Asian primary CCHD caregiver experiences and will help in improving psychosocial support services in Sri Lanka.

Blessing or curse: the role of authoritarian filial piety and self-efficacy in caregiver gains among Chinese family caregivers caring for physically impaired older adults

BACKGROUND

This study investigated the effects of authoritarian filial piety (AFP) and caregiver self-efficacy on the caregiving experience of adult children of physically impaired older adults. Socio-cultural stress and coping model was applied to test the influence of AFP on caregiver gains.

METHODS

A total of 601 Chinese adult children caregivers and care-recipient dyads participated in this cross-sectional study in 2021. Four instruments were used to collect data: the 4-item Zarit Burden Interview, Positive Aspects of Caregiving Scale, Caregiver Task Inventory Scale, and Authoritarian Filial Piety Scale. All mediation and moderated mediation effects were estimated using SPSS 26.0.

RESULTS

Caregiver self-efficacy was found to not only mediate but also help family caregivers convert their burden into positive gains. AFP moderates the association between caregiver burden and self-efficacy, as well as between caregiver burden and caregiver gains.

CONCLUSIONS

This study provides valuable insights into filial piety, elucidating AFP's comprehensive impact on cognitive appraisals of caregiving. Culturally sensitive psychoeducational therapy, addressing AFP expectations and boosting caregiver self-efficacy, is recommended to enhance positive caregiving outcomes.

Depression in caregivers of patients with schizophrenia: a scoping review

PURPOSE

Caregivers play a vitally important role in the lives of people with schizophrenia. However, their mental health can often be overlooked. In recent years, with increasing attention to mental health and wellness, common mental illness such as depression in caregivers of people with schizophrenia has received renewed attention. The purpose of this review was to consolidate and synthesize recent literature on (1) the prevalence of depression in caregivers of people with schizophrenia, (2) factors associated with depression in caregivers of people with schizophrenia, and (3) interventions that target depression in caregivers of people with schizophrenia.

METHODS

A systematic search focusing on literature published between 2010 and 2022 was done to retrieve relevant articles from the following databases: Ovid MEDLINE, Ovid EMBASE, and Ovid Psych INFO.

RESULTS

Twenty-four studies met inclusion criteria and were included in the review. Nine evaluated the prevalence of depression, 18 evaluated factors associated with depression in caregivers, and 6 examined interventions targeting depression. The prevalence of depression and depressive symptoms in samples of caregivers ranged between 12 and 40% across the studies. Females, especially mothers of people with schizophrenia, were more likely to experience depression, followed by younger caregivers. Several factors, including gender, interpersonal relationships, social support, stigma, literacy, and financial constraints, were identified as factors associated with depression in caregivers. Several interventions like yoga, emotional training, and psychoeducation were evaluated, and they showed a significant reduction in the level of depression and depressive symptoms experienced by the caregiver population.

CONCLUSIONS

Depression in caregivers in this clinical population may be widespread and warrants further study. There are promising interventions that can target depression in caregivers. Well-designed longitudinal studies may help identify caregivers at risk of developing depression and further inform targets for intervention.

Explaining Iranian midwives' experiences of providing healthcare services during the COVID-19 pandemic: a qualitative study

BACKGROUND

COVID-19 has changed and challenged the way health and maternity care is provided. Midwives are among the first and most influential maternity care providers during the COVID-19 pandemic; however, there is inadequate information about their experiences in providing healthcare services, particularly in Iran. The present study was conducted to explain the midwives' experiences of providing healthcare services during the COVID-19 pandemic in Gorgan.

METHODS

The present study was conducted qualitatively through the inductive content analysis method in 2022. Data were collected through semi-structured interviews. A total of 21 individuals were selected as participants using a purposeful method and the maximum diversity strategy.

RESULTS

Data analysis led to the emergence of 377 codes, 12 subcategories, and 3 main categories, including, the laborious occupational challenges for midwives during the pandemic, identifying and creating new opportunities for the development of the midwifery profession, and the lack of perceived organizational and social support.

CONCLUSIONS

During the COVID-19 pandemic, midwives experienced various challenges in providing healthcare services, yet sacrificed themselves to perform their duties and provide quality care incessantly. The COVID-19 pandemic was a combination of laborious occupational challenges and individual and professional growth opportunities for midwives in Iran. Strong and managed organizational support is essential to overcome the crisis, maintain the workforce, and empower them to deal with future crises.

Family Caregivers' Role in Navigating Diet: Perspectives from Caregivers of Older Asian Americans

Family caregivers uphold significant healthcare responsibilities including language translation and diet management. This study sought to understand family caregivers' experiences and challenges navigating and managing their older Asian American relative's diet. We conducted an exploratory sequential mixed-methods study with family caregivers involving (1) qualitative interviews (n = 40) and (2) a nationwide survey (n = 100). Interviewees discussed their role and challenges with (a) applying American/Western clinical dietary recommendations to their relative's traditional meal preferences and (b) managing misalignment between their relative's traditional dietary preferences and the food offered in hospitals and long-term care environments. Survey responses triangulated; almost 65% of family caregivers prepared and brought traditional meals to healthcare facilities upon observing a lack of culturally relevant food options. Culturally relevant nutrition training for family caregivers can help them support their relative in community settings. Creating an inclusive healthcare system requires transforming the food environment within healthcare facilities.

Understanding the role of parents' information sharing and withholding on emerging and young adults' caregiving and coping during their parents' advanced cancer

Emerging and young adult caregivers (EYACs) who provide care to their parents are a hidden, unsupported population of caregivers. Research identifies information sharing or withholding as a key aspect of caregivers' ability to cope and adjust, which may be especially critical when a parent is diagnosed with advanced cancer. The goal of this study was to examine the impact of parent information sharing/withholding on EYACs' caregiving and coping experiences. We conducted in-depth, semi-structured interviews with 33 EYACs between the ages of 18-35 who cared for a parent that died of advanced cancer. Interview transcripts were thematically analyzed. Three factors played a role in how parents' information sharing/withholding affected EYACs' caregiving/coping: 1) topic, 2) timing, and 3) who is included. Findings highlight the adaptive functioning of parents' information sharing and negative outcomes associated with information withholding, illustrating how parents' disclosure decisions function to promote or inhibit EYACs' care involvement and coping.

Hospital care experiences of female relatives caring for patients with post-stroke dysphagia during the COVID-19: a qualitative study in China

BACKGROUND

Due to the COVID-19 epidemic, Chinese hospitals are forced to impose stringent regulations, which unavoidably affect patients with stroke who need continued rehabilitation and long-term disease treatment. However, there is a lack of qualitative studies in the literature on female relative caregivers of hospitalised patients who had a stroke with dysphagia during the COVID-19 pandemic.

OBJECTIVE

In this study, we aimed to explore the experiences of female Chinese caregivers living in the hospital with patients with post-stroke dysphagia during the pandemic.

DESIGN

We conducted a qualitative study using semi-structured interviews.

SETTINGS

From May 2022 to July 2022, patients were selected from the Acupuncture and Moxibustion Ward and the Encephalopathy Ward of Shenzhen Chinese Medicine Hospital, which receives patients from across the country.

PARTICIPANTS

10 Chinese women who were caregivers of patients with post-stroke dysphagia were finally interviewed.

METHODS

Interviews were transcribed verbatim and analysed using Colaizzi's approach.

RESULTS

The primary theme was determined to be 'kidnapped' lives. Other sub-themes evolved to depict the lives of female relative caregivers, including inevitable tasks and challenges, precise care, a special dietary pattern, solitary and forgotten, and an elusive future. Due to the trivial nature of caring for patients who had a stroke with dysphagia, the caregivers' lives were tightly organised and entirely dictated by the patient's caring needs. Consequently, the caregivers felt that their lives had been kidnapped.

CONCLUSIONS

It is imperative that healthcare workers identify and understand the living conditions of female relative caregivers in the hospital, so as to determine their difficulties and needs. Finally, caregivers deserve adequate and effective support, such as technical support, financial support and nutritional guidance.

The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study

BACKGROUND

Cancer morbidity and mortality is rising in sub-Saharan Africa. Given this rise, family caregivers play an integral role in provision of quality cancer care services. This study explored the family caregivers (FCGs)/relatives' experiences of caring for patients with advanced cancer (stage 3 or stage 4) in Uganda.

METHODS

This was a descriptive qualitative study exploring the lived experiences of FCGs of patients with advanced cancer attending care at the Uganda cancer institute. We purposively recruited twelve FCGs and conducted face-to-face in-depth interviews using an interviewer-guided semi-structured questionnaire. Data were analyzed by thematic analysis.

RESULTS

The age range of participants was 19 to 49 years. Most participants were children of the patients (n = 7), had attained tertiary education (n = 7), and had taken care of their loved ones for at least one year (n = 10). Six themes emerged from data analysis; (i) caring roles, (ii) caring burdens, (iii) role conflict, (iv) health system tensions, (v) support and motivation, (vi) caring benefits, lessons and recommendations.

CONCLUSION

Study findings highlight the fundamental role of FCGs in the care of their loved ones, and illuminate the neglected physical, psychological and social challenges of family caregivers amidst health system tensions and conflicting roles. The needs of family caregivers should be embedded within cancer care, prevention and control programs particularly in low resource settings.

"Caregiving Youth" and the Patchwork History of Recognition in the United States

This article examines the U.S. legislative and policy landscape and its historical and contemporary recognition of young people as caregivers and their importance to public health, both as care providers and as a category of special concern for overall wellbeing. Drawing on feminist geographies of health to situate a historical analysis, we aim to answer two key questions: First, what is the history of recognition of caregiving youth in key moments of federal action to address family caregiving needs? Second, how might we use this history to better understand and analyze the patchwork geography of caregiving youth recognition in the U.S. and other countries that similarly lack formal national policy recognition to improve and enhance public health? We use the term patchwork to describe how federal recognition of caregiving youth in broader debates about public health is uneven across both time and space, and contingent upon civil society, non-profit organizations, and researchers working in and with geographically bound communities. Our results illustrate how a focus on the relationships of recognition, both in the past and the present and at local and national scales, reveals a different perspective on caregiving youth in the U.S. with a much more complex history than previously identified. The article describes how relationships established in the absence of federal policy or legislation are sometimes directed towards building more formal recognition, and other times with the goal of changing practices in a specific location.

A life-changing process when living with chronic kidney disease: A qualitative study

BACKGROUND

Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life.

OBJECTIVE

Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment.

DESIGN

An explorative study using a qualitative method with a phenomenological-hermeneutic approach.

PARTICIPANTS

Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members.

APPROACH

Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion.

FINDINGS

One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone.

CONCLUSION

There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.

Projections of costs and quality adjusted life years lost due to dementia from 2020 to 2050: A population-based microsimulation study

INTRODUCTION

Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia.

METHODS

We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting.

RESULTS

Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%).

DISCUSSION

To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency.

Characteristics and predictors of family accommodation in Turkish individuals with obsessive-compulsive disorder

BACKGROUND

Family accommodation (FA) is associated with disease severity and response to treatment rates in patients with obsessive-compulsive disorder (OCD) and is therefore particularly important in this patient group. This study investigated the structure of FA and associated factors in a Turkish society sample.

METHODS

The study was carried out with 92 patients diagnosed with OCD for at least 1 year, who applied to Alanya ALKU Training and Research Hospital psychiatry outpatient clinic between February 2021 and March 2022. Sociodemographic data form, Family Accommodation Scale-Patient Form (FAS-PF), Dimensional Obsessive-Compulsive Scale (DOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Acceptance and Action Questionnaire (AAQ-II) were applied to all of the cases. Relatives filled out the Sociodemographic Data.

RESULTS

The mean age of the patients was 32.11 ± 11.56 years. Sixty-nine (75%) of the patients were women. Fifty (54.3%) patients weremarried. All participants reported FA behavior at least once in the previous week. FA exhibited no significant variation by sex (p = 0.679)or marital status (p = 0.256). Significant positive correlation was determined between DOCS-T (r = 0.370, p < 0.001), AAQ-II (r = 0.261, p = 0.013), BDI (r = 0.235, p = 0.024) and BAI (r = 0.342, p = 0.001) scores and the FAS-PF. In the regression analysis, only OCD disease severity predicted FA [(β = 0.295, p = 0.036, 95% confidence interval (95% CI) = 0.02 to 0.55)]. Higher FA scores were obtained in this study (23.93 ± 15.28) compared to previous research in Western societies (14.3 ± 15.2).

DISCUSSION

Clinicians should consider FA in the examination of OCD patients. High FA values for both frequency and severity suggestthat interventions directed toward FA may be associated with more positive outcomes in outpatient Turkish patients with OCD.

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.

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma

BACKGROUND

The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers' burden can lead to a reduction in caregivers' involvement. There is a relationship between caregivers' involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers' burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda.

METHODS

A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers.

RESULTS

The findings indicate that affiliated stigma serves as a full mediator between the caregiver's roles and involvement (β=15.97, p<0.001). Being female increased the caregivers' burden of caregiving (β= -0.23, p<0.001).

CONCLUSION

The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study

This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.

Comprehensive Understanding of Hispanic Caregivers: Focus on Innovative Methods and Validations

Alzheimer’s disease (AD) and Alzheimer’s disease-related disorders (ADRD) are late-onset, age-related progressive neurodegenerative disorders, characterized by memory loss and multiple cognitive impairments. Current research indicates that Hispanic Americans are at an increased risk for AD/ADRD and other chronic conditions such as diabetes, obesity, hypertension, and kidney disease, and given their rapid growth in numbers, this may contribute to a greater incidence of these disorders. This is particularly true for the state of Texas, where Hispanics are the largest group of ethnic minorities. Currently, AD/ADRD patients are taken care by family caregivers, which puts a tremendous burden on family caregivers who are usually older themselves. The management of disease and providing necessary/timely support for patients with AD/ADRD is a challenging task. Family caregivers support these individuals in completing basic physical needs, maintaining a safe living environment, and providing necessary planning for healthcare needs and end-of-life decisions for the remainder of the patient’s lifetime. Family caregivers are mostly over 50 years of age and provide all-day care for individuals with AD/ADRD, while also managing their health. This takes a significant toll on the caregiver’s own physiological, mental, behavioral, and social health, in addition to low economic status. The purpose of our article is to assess the status of Hispanic caregivers. We also focused on effective interventions for family caregivers of persons with AD/ADRD involving both educational and psychotherapeutic components, and a group format further enhances effectiveness. Our article discusses innovative methods and validations to support Hispanic family caregivers in rural West Texas.

A systematic review and narrative synthesis of the experiences with caring for older people living with dementia in Sub-Saharan Africa

BACKGROUND

In low- and middle-income countries, including sub-Saharan Africa little is known about the experiences with caring for people living with dementia. The purpose of this systematic review and narrative synthesis was to examine the experiences with caring for older people living with dementia at home.

RESULTS

In total, 366 abstracts were identified and following screening, 19 studies were included in the synthesis. Six themes were identified: conceptualising dementia, caregiving arrangements, the impact of caregiving, caregiver identity and role, managing caregiving, unmet caregiver needs.

CONCLUSION

There is a dearth of research in relation to caregiving for older people living with dementia in sub-Saharan Africa. There is need for better information campaigns and support programs directed at family and professional caregivers in this context.

Integrated Diabetes Self-Management (IDSM) mobile application to improve self-management and glycemic control among patients with Type 2 Diabetes Mellitus (T2DM) in Indonesia: A mixed methods study protocol

The number of patients with diabetes in Indonesia reach 19,47 million in 2021, mostly is caused by the adoption of sedentary and unhealthy lifestyles. Continuous self-management is important in diabetes care. It requires optimal coordination and communication between patients, families, and health care provider. The use of communication technology could be solution to the problem. This study aims to initiate an android-based mobile apps technology as a tool for patient, family, and healthcare provider to optimize patient with T2DM treatment. This study will be conducted in Public Health Centers (PHCs) in Yogyakarta using an exploratory sequential mixed-methods design which is divided into three phases. The first phase will use qualitative descriptive methods. Patients with T2DM, families, nurses, physicians and Health Social Security Agency officers in Indonesia will be involved in a focus group discussion (FGD) and in-depth interviews to understand their needs in optimizing the treatment. The second phase will be the development of an android-based application on the first phase results. The apps will be usability tested by involving experts (heuristic evaluation) and users (think aloud method) to ensure that the apps really meet targeted user's need. In the third phase, we will collect feedback from user after using this apps for three months. The effectiveness of the apps will be measured by self-management improvement and glycemic control of patients with T2DM. The non-equivalent control group design will be applied using a pre-repeated post-test control group. The result of this study will be an Android-based Application which will be called Integrated Diabetes Self-Management (IDSM) app to optimize the implementation of diabetes self-management which can improve glycemic control of patients with T2DM as one of the indicators of the Indonesian Chronic Disease Management Program at PHCs.

Cultural factors associated with burden in unpaid caregivers of older adults: A systematic review

The aim of the present systematic review was to investigate cultural factors associated with burden in unpaid caregivers of older adults. Searches were conducted in the Pubmed, Web of Science, PsycInfo, Scopus, Embase, LILACs and SciELO databases for relevant articles published in English, Portuguese and Spanish using the search terms 'Caregiver AND Culture AND (Burnout OR Caregiver Burden) AND Aged'. No restriction was imposed regarding year of publication. A total of 1234 articles were identified, 34 of which were selected for the present review. The following sociodemographic characteristics were associated with burden: being female, married, White caregivers, young and the spouse of the care recipient; having no siblings; having low schooling and low economic status. Cultural factors associated with burden were living with the care recipient, not professing a religion or having little spirituality, familism (i.e. less reciprocity) and an absence of social support. The present findings underscore the importance of developing intervention strategies that consider cultural factors to minimise the negative impacts of care on unpaid caregivers of older adults.

Systematic Review of Dyadic Interventions for Ambulatory Care Sensitive Conditions: Current Evidence and Key Gaps

OBJECTIVES

Identify non-pharmacological interventions to support patient/caregiver dyads with ACSCs; review the effects of dyadic interventions on health services outcomes; and review the effectiveness of dyadic interventions on patient and caregiver biopsychosocial outcomes.

METHODS

A systematic review of randomized controlled trials (RCTs).

RESULTS

Twenty-six manuscripts representing 20 unique RCTs (Mean N = 154 patients, 140 caregivers) were eligible. Eleven RCTs examined caregiving in patients with HF, seven with T2DM, one with COPD, and one with mixed ACSCs. Dyadic interventions for ACSCs were diverse in terms of length and content, with most including an educational component. Only 4/26 included studies had a low risk of bias. Interventions were most successful at improving quality of life, clinical health outcomes, health behaviors, and health services outcomes, with fewer improvements in patient mental health outcomes, psychosocial outcomes, relationship outcomes, and caregiver outcomes in general. The largest effect sizes were reported from trials focused on T2DM.

CONCLUSIONS

High-quality research with consistent measuring instruments is needed to understand which interventions are associated with improved patient and caregiver outcomes.

CLINICAL IMPLICATIONS

There may be clinically relevant benefits to including caregivers in interventions for patients with ACSCs, and clinicians should consider this when devising treatment plans.

Association between increased caregiver burden and severe psychological distress for informal caregivers during the COVID-19 pandemic in Japan: A cross-sectional study

Objective

During the coronavirus disease 2019 (COVID-19) pandemic, informal caregivers’ mental health deteriorated more than that of non-caregivers. We examined the association between increased caregiver burden during the pandemic and severe psychological distress (SPD).

Methods

We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were included. SPD was defined as Kessler 6 Scale (K6) score ≥ 13. Self-rated change in caregiver burden was measured retrospectively with a single question item. Binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden during the pandemic, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted for all variables.

Results

Participants’ mean age was 52.3 years (standard deviation 15.9), 48.8% of participants were male, 56.7% reported increased caregiver burden, and 19.3% exhibited SPD. Increased caregiver burden was significantly associated with SPD (adjusted odds ratio: 1.90; 95% confidence interval: 1.37–2.66). The association between increased caregiver burden and SPD was stronger among caregivers who were married, those undergoing disease treatment, and those with a care-receiver with a care need level of 1–2.

Conclusions

The results revealed that more than half of caregivers reported increased caregiver burden, and increased caregiver burden was associated with SPD during the pandemic. Measures supporting mental health for caregivers with increased caregiver burden should be implemented immediately.

Greater Inclusion of Asian Americans in Aging Research on Family Caregiving for Better Understanding of Racial Health Inequities

With the substantial demographic changes in racial composition in the United States since 1965, research on racial health inequities must build upon the Black-White binary to assess the complex ways "race" affects health and aging. Considering variation in the prevalence and meanings of aging across racialized groups requires concerted efforts to expand and disaggregate samples. Aligned with the goals of the intersectionality framework, we argue that greater inclusion of Asian Americans is critical to advance both theoretical and methodological considerations that enable us to investigate the lived experiences of Asian Americans. Using caregiving as an example, we discuss how systemic, cultural, and interpersonal marginalization from racism and other oppressive systems intertwine with "race" to produce the race effects. Greater inclusion of Asian Americans helps further provide the opportunity to conceptualize culture as dynamic and interacting with structure to produce different racial patterns. Meaningful inclusion of Asian Americans in research requires more systemic effort to collect accurate, reliable, and quality data for Asian Americans that can be disaggregated by other important axes of stratification.

Long-distance caregiving at the end of life: a protocol for an exploratory qualitative study in Germany

Background

Of the approximately 4.7 million people in Germany caring for a relative, many live at a geographical distance from their loved one. The provision of remote care to a terminally ill patient is associated with specific challenges and burdens. In the German context, research is lacking on the specific experiences and needs of caregivers in end-of-life situations who are geographically distanced from their relative. Thus, the overarching goal of the proposed study is to detail the specifics of long-distance caregiving at the end of life in Germany, determining the role played by physical distance in shaping end-of-life caregiving and identifying the needs of long-distance caregivers in this situation.

Methods

The exploratory qualitative study will be guided by an inductive logic, drawing on one-time semi-structured interviews. To uncover the multiplicity of caregiving experiences, long-distance caregivers of both patients receiving early palliative care and patients at a very advanced stage of disease will be included. The study will be divided into five phases: (1) preparation and pretest, (2) data collection and primary analysis, (3) data analysis and interpretation, (4) advisory board workshop and (5) conclusions and recommendations.

Discussion

The study will aim at generating valuable insight regarding the experiences and needs of family caregivers of end-of-life patients. This is particularly relevant, given that families are becoming increasingly geographically dispersed. As this trend continues, it will challenge traditional models of family care and shed light on novel caregiving issues that will need to be addressed through social and health policy.

Trial registration

The study was prospectively registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00024164; date of registration: January 25, 2021), and is searchable under the International Clinical Trials Registry Platform Search Portal of the World Health Organization, under the German Clinical Trials Register number.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00967-8.

Applying the Dual Filial Piety Model in the United States: A Comparison of Filial Piety Between Asian Americans and Caucasian Americans

The definition and measurement of filial piety in existing research primarily focuses on the narrow conceptualizations of Asian filial piety, which would inflate cultural differences and undermine cultural universals in how people approach caring for their elderly parents. Employing the Dual Filial Piety Model (DFPM), this study aimed to examine the relationship between filial piety and attitude toward caring for elderly parents beyond the Asian context. In our study (N = 276), we found that reciprocal filial piety (RFP) does not differ across cultures while authoritarian filial piety (AFP) does. We also found that collectivism, rather than ethnicity, predicted RFP and AFP, which in turn predicted positive attitude toward caring for elderly parents. Our work demonstrates the cross-cultural applicability of the DFPM and highlights the universal and culture-specific aspects of filial piety.

The effects of caregiver characteristics on behavioral and psychological symptoms of dementia of patients with dementia

OBJECTIVE

To determine the association between caregiver characteristics and behavioral and psychological symptoms of dementia (BPSD) in patients with dementia (PWD) in a Taiwanese community-dwelling population.

METHODS

This cross-sectional study was conducted using the data of 190 patients with Alzheimer's disease/dementia and 190 informal matched caregivers in Taiwan. BPSD were examined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were used to explore associations between caregiver characteristics and the presence, severity, and distress of NPI-Q items.

RESULTS

Only spouse primary caregiver was positively associated with presence of delusions in PWD. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference in PWD, while child primary caregiver was positively related to severity of disinhibition in PWD but negatively related to severity of anxiety in PWD. Spouse primary caregiver was positively related to severity of anxiety and appetite/eating in PWD while sole primary caregiver was positively related to severity of anxiety and nighttime behaviors in PWD. Caregiver education was positively correlated to distress of agitation/aggression in caregivers while child primary caregiver was positively related to distress of disinhibition in caregivers. Spouse primary caregiver was positively related to distress of anxiety and appetite/eating in caregivers while spouse caregiver was positively related to distress of nighttime behaviors in caregivers.

CONCLUSIONS

Caregiver education, child and spouse primary caregiver were relevant to severity of PWD and distress of caregivers of BPSD. It is suggested that healthcare professionals provide caregivers with proper individualized interventions based on these results to enhance caring quality.Key pointsCaregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference, and distress of agitation/aggression.Child primary caregiver was positively related to severity and distress of disinhibition but negatively related to severity of anxiety.Spouse primary caregiver was positively related to severity and distress of anxiety and appetite/eating, and distress of nighttime behaviors.

Becoming a Caregiver: Experiences of Young Adults Moving into Family Caregiving Roles

While the vast majority of family caregivers struggle to find balance between different roles in their lives, young adult caregivers are faced with the atypical challenge of caring for family member while simultaneously accomplishing developmental tasks typical of this stage in life (e.g., establishing career, developing romantic relationships). This exploratory, qualitative study examined strategies used by young adults to adopt family caregiving roles. These strategies can be described as embracement, compromise, and integration. While each approach allowed for the young adult to facilitate their caregiving role, additional research is needed to understand how the strategy affects the emerging adult's development.

The effect of informal caregiving on physical health among non-migrants and Ethnic German Immigrants in Germany: a cohort analysis based on the GSOEP 2000-2018

BACKGROUND

The number of people in need of care in Germany has been rising since decades, which is related to an increasing need and relevance of informal caregiving. Likewise, the number of people with a migration background has been increasing. This study aims to analyse the impact of informal caregiving on physical health in comparative perspective for Ethnic German Immigrants (EGI) - the largest and oldest immigrant group in Germany - and non-migrant Germans (NMG).

METHODS

The sample was drawn from the years 2000-2018 of the German Socio-Economic Panel (n = 26,354). NMG (n = 24,634) and EGI (n = 1,720) were categorized into non-caregivers (n = 24,379) and caregivers (n = 1,975), where the latter were distinguished by 1) their caregiving status and history (current, former, and never caregiver) and 2) the number of years in the caregiver role. Generalized Estimating Equations were applied to examine main effects and the interaction effects of caregiving status and migration background for changes in physical health (n = 102,066 observations).

RESULTS

Adjusting for socioeconomic, household related, and individual characteristics, NMG and EGI had similar caregiving patterns and physical health. However, the interaction between migration background and caregiving revealed significantly higher declines in physical health for currently caregiving EGI. Sensitivity analyses indicated that particularly socioeconomic resources moderated this effect.

CONCLUSIONS

Findings suggest that caregiving is associated with declines in physical health, particularly in the long term and for EGI. This implies that care-related disadvantages accumulate over time and that the association of caregiving, health and associated determinants are culturally diverse and shaped by migration background. Both the health disadvantages of caregivers and EGI might be mitigated by a positive social and socioeconomic setting, which highlights the relevance of supporting structures and benefits for these subgroups.

Characteristics associated with neuropsychiatric symptoms in persons living with dementia and caregiver distress and diminished well-being

BACKGROUND

The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal.

PURPOSE

To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49).

METHODOLOGY

Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics.

RESULTS

Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life.

CONCLUSIONS

Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being.

IMPLICATIONS

Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.

The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic

The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart.

Māori elders’ perspectives of end-of-life family care: whānau carers as knowledge holders, weavers, and navigators

Background:

There is growing interest in palliative care within Indigenous communities, and within Aotearoa New Zealand, of the significant role that Māori (Indigenous people) families play in caring for older relatives. This study explored the centrality of culture in how Māori extended families (whānau) in Aotearoa New Zealand interpret and enact family-based care roles within the Māori world (Te Ao Māori).

Methods:

Applying Māori-centered and community-based participatory research principles, we examined 17 interviews with older Māori who shared experiences of palliative care for a partner or family member. The thematic analysis used a cultural-discursive framework incorporating Māori principles of wellbeing and values expressed within the care relationship.

Results:

The findings centered on three whānau roles in palliative care: whānau as (1) Holders and protectors of Māori knowledge; (2) Weavers of spiritual connection; and (3) Navigators in different worlds.

Conclusion:

The study problematizes the notion of a single ‘primary caregiver’, privileges whānau as an inter-woven relational, dynamic care network, and encourages health professionals to recognize the cultural embeddedness of dominant approaches to palliative care.

Burden and Heart Rate Variability in Bipolar Disorder Family Caregivers

Family caregivers of persons with bipolar disorder experience considerable stress. Yet, studies have not examined whether their stress differs by race and gender. This preliminary analysis of baseline data from 228 African American and White family caregivers of adults with bipolar disorder who were enrolled in a randomized controlled trial examined race and gender differences on two validated self-report measures of psychological stress (caregiver burden and caregiver reactions) and an electrocardiography device used to capture heart rate variability (HRV). No statistically significant differences were found by race or gender on either measure of psychological stress. African American caregivers had significantly lower scores on two indices of HRV compared to White caregivers. Women had significantly lower scores on one index of HRV compared to men. Low HRV indicates greater stress and mortality risk. Future research should include HRV to measure caregiver stress and implement relevant interventions.

Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review

BACKGROUND

In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure.

AIMS

This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps.

MATERIALS & METHODS

A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020.

RESULTS

A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach.

DISCUSSION

This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.

Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study

Background

Despite the large treatment gap in Indonesia, limited studies have attempted to explore both service users’ and providers’ evaluations of the current mental health system holistically. This study aims to explore the perceived challenges and support needs of Indonesian mental health stakeholders.

Methods

This qualitative study collected data from 17 participants from two mental health stakeholders in Yogyakarta (i.e., health professionals and service users) through a semi-structured interview. Thematic analysis was used to analyze the data.

Results

Findings reveal that service providers and users shared equally strong concerns regarding challenges and needs for improving mental health literacy, accessibility to services, and government support. However, a distinct emphasis was made in several areas—with service providers hinting more towards issues with interprofessional collaboration. In contrast, service users emphasized the negative attitude of health professionals and poor accessibility to service information.

Conclusion

The mental health service system is challenged by the lack of accessibility to service information, the limited spread of mental health practitioners, stigma, and lack of mental health literacy among both the public and professionals. A need for improvement in mental health promotion, accessibility, and quality of mental health workers is highlighted to satisfy the needs of both service users and providers.

"The Continuous Shadow of My Mother's Breast Cancer": exploring the voice of daughters

PURPOSE

Women whose mothers have been diagnosed with breast cancer are concerned about their mothers' illness and fear developing cancer themselves. This study, conducted in Taiwan, aims to understand daughters' lived experiences after their mothers were diagnosed with breast cancer.

METHOD

In-depth interviews were conducted to understand daughters' emotional reactions to their mothers' diagnoses, their challenges with taking care of their mothers, and their concerns or perceptions regarding their own risks of developing breast cancer. Themes were identified using a phenomenological approach with 18 transcripts.

RESULTS

Six themes were identified: "taking care of my mother is my responsibility", "desiring sufficient information/support", "feeling helplessness in providing care", "expecting a cancer diagnosis in fear", "anticipating reassurance other than surveillance", and "worrying about myself is not a priority". In addition, these themes reflected their concerns about how to support their mothers physically and psychologically, how to manage their own worries about cancer, and how to maintain their health.

CONCLUSION

The daughters prioritized the responsibility of caring for their mothers physically and psychologically rather than managing their own cancer concerns. Health care professionals should be aware of these priorities to provide education regarding the care of high-risk populations and psychological support to adult daughters.

Limitations in representative sampling of unpaid caregivers from minority ethnocultural backgrounds in a population-based survey

OBJECTIVE

Historically, persons from minority ethnic, religious and linguistic backgrounds have been un- or under-represented in population-based research studies. Emerging scholarship suggests challenges in representative sampling, particularly of minority ethnocultural groups, has been exacerbated by the COVID-19 pandemic. This research note offers additional insights concerning these challenges in the context of a population-based survey of unpaid caregivers conducted in Ontario, Canada, between August and December, 2020, the analysis of which is currently underway.

RESULTS

Beyond limitations intrinsic to study design, including time and budget constraints, the study sample underrepresents unpaid caregivers from minority ethnocultural backgrounds due to differences in conceptions of caregiving across minority cultures, the time-consuming nature of caregiving that disproportionately affects minority groups, and a propensity to avoid research which is rooted in tokenism. These hypotheses are non-exhaustive, speculative and warrant further empirical investigation.

Smiles behind the masks: A systematic review and narrative synthesis exploring how family members of seriously ill or dying patients are supported during infectious disease outbreaks

BACKGROUND

Infection control measures during infectious disease outbreaks can have significant impacts on seriously ill and dying patients, their family, the patient-family connection, coping, grief and bereavement.

AIM

To explore how family members of patients who are seriously ill or who die during infectious disease outbreaks are supported and cared for during serious illness, before and after patient death and the factors that influence family presence around the time of death.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

CINAHL, Medline, APA PsycInfo and Embase were searched from inception to June 2020. Forward and backward searching of included papers were also undertaken. Records were independently assessed against inclusion criteria. Included papers were assessed for quality, but none were excluded.

FINDINGS

Key findings from 14 papers include the importance of communication and information sharing, as well as new ways of using virtual communication. Restrictive visiting practices were understood, but the impact of these restrictions on family experience cannot be underestimated, causing distress and suffering. Consistent advice and information were critical, such as explaining personal protective equipment, which family found constraining and staff experienced as affecting interpersonal communication. Cultural expectations of family caregiving were challenged during infectious disease outbreaks.

CONCLUSION

Learning from previous infectious disease outbreaks about how family are supported can be translated to the current COVID-19 pandemic and future infectious disease outbreaks. Consistent, culturally sensitive and tailored plans should be clearly communicated to family members, including when any restrictions may be amended or additional supports provided when someone is dying.

Maternal experiences of caring for preterm infants in a vulnerable South African population

Background

Caring for a preterm infant is known to be a stressful experience as these infants are at a high risk of medical sequelae and developmental delays. Early intervention is imperative for the best developmental outcome for the infant. Such interventions are often delivered through the mother or primary caregiver; however, healthcare professionals are seldom aware of all the factors that influence maternal well-being, potentially influencing her ability to provide optimal care.

Aim

To explore the experiences of a group of vulnerable women, namely, isiXhosa-speaking mothers of preterm infants living in low socio-economic circumstances in the Western Cape province of South Africa, regarding having, caring for and feeding their preterm infants within the first 6 months of the infant’s life.

Setting

A follow-up clinic for preterm infants and their mothers at a public tertiary hospital in Cape Town, South Africa.

Methods

The study employed a qualitative, cross-sectional design that was explorative and contextual in nature. A discussion schedule was used to guide 15 in-depth interviews with mothers that were later thematically analysed.

Results

Social support and religion positively influenced maternal coping. The infant’s medical stability was the main concern for mothers and concerns regarding the infant’s development did not arise. Prematurity influenced mothers’ decisions to use traditional medicines and hospital care affected some traditional practices.

Conclusion

The study findings highlighted the influence of traditional and religious beliefs, the importance of the cultural education of medical staff members and a support system to improve maternal experiences.

Contribution

The findings provide insights into maternal experiences with implications for healthcare practitioners’ continued education in an ethnically diverse setting.

Gendered experiences of providing informal care for older people: a systematic review and thematic synthesis

Background and purpose

The caregiving’s impact on informal carers’ quality of life and gender-based stereotypes make older individuals’ informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers’ experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020.

Design and methods

The systematic method for reviewing and synthesising qualitative data was performed using the PRISMA checklist and ENTREQ statement. The CASP tool was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework.

Results

This review produced two analytical themes, the impact of gender on the caregivers’ labour and negotiating gender identity with self, society, and cultural norms. While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts caregiving burden and coping strategies. Informal carers’ experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers’ healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers’ negotiations between self and society on developing their new caregiving identity. Providing intensive informal primary care to older people affects both men’s and women’s mental and physical health. Gender ideals of the feminine nurturing role further disadvantage women as they determine the caregiving arrangements, the strategies and resources to sustain the caring burden, and the adaptability to experience their new caregiving role positively. Men appear more flexible to debate their hegemonic masculinity and defend their existence in the caregiving role.

Conclusion and implications

Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people’s care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06736-2.

Caregiver resource utilization: Intellectual and development disability and dementia

BACKGROUND

Adults with intellectual and developmental disabilities and their families have high need for support services. This study assessed resource utilization among caregivers of intellectual and developmental disabilities and other conditions.

METHODS

We assessed 366 caregivers of adults with intellectual and developmental disabilities, dementia or other conditions Regressions assessed group differences in number of agency contacts and frequency of service use. A secondary analysis assessed reasons for underutilization of services.

RESULTS

Caregivers of individuals with dementia contacted twice as many agencies as other caregivers and were more likely to report using suggested services. Agency contact and service utilization were similar among caregivers of adults with intellectual and developmental disabilities compared to other caregivers. Caregivers of adults with intellectual and developmental indicated that suggested services were unavailable to them.

CONCLUSION

The findings of this study shed light on challenges with access to and utilization of support services.

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12–16 years; N = 16) and young adults (18–24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom’s role as primary caregiver and dad’s role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

Psychometric properties of the Kingston Caregiver Stress Scale in Romanian caregivers of children and adults with disabilities

BACKGROUND

The Kingston Caregiver Stress Scale (KCSS) was designed to measure stress in caregivers of people with dementia, but empirical studies have used this instrument to measure stress in caregivers of children and adults with disabilities, without investigating its psychometric properties.

AIMS

This study analysed the factor structure, reliability, and validity of the KCSS in Romanian caregivers of children and adults with disabilities.

METHODS AND PROCEDURES

A total of 276 familial caregivers of children and adults with various disabilities completed measures of caregiver stress and related concepts. After 3 months, 72 participants were retested.

OUTCOMES AND RESULTS

A new bifactorial model with eight items was compared against the originally proposed trifactorial model and a previously proposed bifactorial model with 10 items. The bifactorial eight-item model had the best fit indices (χ2 = 41.4, df = 19, p = .002, CFI = .981, TLI = .971, RMSEA = .065 [90 % CI = .038, .092]), along with good test-retest reliability and convergent, divergent, and predictive validity of anxiety and depression.

CONCLUSIONS AND IMPLICATIONS

The KCSS is a reliable instrument for assessing caregiver stress among caregivers of children and adults with disabilities. Implications, limitations, and future research suggestions are discussed.

The experience of family caregivers of patients receiving home nasogastric tube feeding in China: A descriptive qualitative study

Background

The value of caregivers with respect to ensuring safety during home nasogastric tube (NGT) feeding is increasingly acknowledged. However, little attention has been given to the experience of caregivers.

Methods

A qualitative descriptive design using semi‐structured interviews via purposive sampling at a comprehensive hospital in China was employed. Family caregivers of patients with home NGT feeding were recruited. Interviews were recorded, transcribed verbatim and analysed qualitatively using inductive content analysis.

Results

Thirteen family caregivers of patients with home NGT feeding were interviewed. Four main themes were generated: negative experience (uncertainty and ambivalence, transition gaps between hospitals and home care services), new role: adapting to the lifestyle (participating in decision‐making, being responsible for everything, adjusting own life to NGT feeding), perceived benefit of caregiving (personal growth, development of positive attitudes and achievements) and expectations (expectations from continuity health system services, expectations from social support).

Conclusions

The present study highlights the vulnerability and perceived benefits embedded in the role of a family caregiver. Improving communication and standardising practices between home and hospitals should be considered.

'Mums are sacred, and mums don't die': A mixed-methods study of adult child-parent dyadic relationships at the end of life

OBJECTIVES

The aim of the present study was to report the specific challenges pertaining to the experiences and needs of (1) terminally ill adult children and their parents and (2) terminally ill parents and their adult children, regarding their relationship and relationship roles. The study sought to identify similar and differing relationship patterns between the two dyadic types.

DESIGN

This prospective observational study used an exploratory mixed-methods approach.

PARTICIPANTS

Patients and caregivers were recruited (Feb. 2018 - Nov. 2019) via general and specialist palliative care providers in Germany.

METHODS

The study combined semi-structured interviews with quantitative questionnaires covering socio-demographic details, attachment style and emotional intimacy.

FINDINGS

A total of 65 patients and 42 family caregivers participated in the study. Interview data indicate that illness situation and dependencies were perceived in both dyads to represent a relationship role reversal contrary to the 'natural order'. With respect to dyad 1, adult children stressed their need for autonomy, whereas caregiving parents strived for greater intimacy in the relationship. Within dyad 2, terminally ill parents and adult children experienced a new relationship intensity. Questionnaire data showed that emotional intimacy was perceived by patients in both dyads and adult child caregivers as significantly higher in the current illness situation compared to the pre-illness situation.

CONCLUSIONS

This was the first study to contribute to an understanding of the different needs of terminally ill adult children/parents and their parent/adult child caregivers, thus contributing to an understanding of the different needs of these parties, both within and between the dyadic forms. The results suggest that the dyads share similar themes, which should be integrated into general support interventions; however, some themes appear more relevant for one dyad, only.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

For both dyads, we recommend psychological counseling to support open communication and understanding between parties.

Authoritative Parents and Dominant Children as the Center of Communication for Sustainable Healthy Aging

The aging population significantly is shifting the center of gravity of the people toward older ages and median age. Indonesia, as one of the most populous countries, needs to prepare for this situation. This study tries to explain whether the elderly’s sedentary lifestyle is the consequence of intergenerational interaction patterns. Filial piety was arguably implemented, as the interaction baseline within a family member affects how the intergeneration communicates. This study uses thematic analysis based on the opinions from 16 respondents’ experiences and values with respect to behavior toward the older generation with a specific inclusion criterion. Sampling structures represented younger-generation adults who interacted daily with the elderly older generation, divided by their marital status, residencies, and living area in Indonesia. Through emerging themes, was is found out that the dominant figure in the family is the communication center in the family. The dominant figure might be an authoritative parent or dominant child. This targeted approach is useful to enhance connectivity within family members, potentially implementing the Internet of Healthy Things (IoHT) for the younger elderly to reduce undesirable sedentary lifestyles and to deliver sustainable healthy aging in Indonesian society.

Caregiving Strategies in Families of Children with Congenital Heart Disease: A Qualitative Study

Background

The families of children with Congenital Heart Disease (CHD) experience challenges in taking care of their child, which may affect the whole family. Therefore, the families need to manage and organize the caregiving process for the child. In order to help families provide optimized and quality care for their child, it is important to understand how they manage caregiving challenges. This study was conducted with the aim to explore the strategies used by families for managing family caregiving for their child.

Materials and Methods

This qualitative study was conducted on families of children with CHD referred to hospitals in Mashhad, Iran. The participants were selected using a purposive sampling method. The data were collected from among 40 eligible participants using in-depth and semi-structured interviews from November 2017 to December 2018. Conventional content analysis was used for data analysis and MAXQDA software for managing the coding process.

Results

According to the results, effort to manage caregiving emerged as the main theme, which included the 4 categories of "monitoring the child's health conditions," "organizing family life," "optimizing family life," and "establishing interaction."

Conclusions

The families used various strategies to manage caregiving including monitoring of the child's health conditions, organization, and optimization of family life, and effective interaction based on their knowledge, experiences, beliefs, and available sources. The results of the present study can help healthcare professionals and nurses to develop family-centered empowerment programs in order to promote families' abilities to manage family caregiving for a child with CHD.

An international systematic review of dementia caregiving interventions for Chinese families

OBJECTIVES

Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally.

METHODS

Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800).

RESULTS

Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy.

CONCLUSIONS

To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.