Caring load and family caregivers' burden in China: the mediating effects of social support and social exclusion

Objective

Caring for older adults with disabilities is a source of stress for family caregivers, and the lack of social support and the pressure of social exclusion might aggravate family caregiver burden. This study aimed to examine the association between caring load and family caregivers' burden, as well as the mediating effects of social support and social exclusion.

Methods

Data used in this study was derived from the nationally representative database of the aged population in China, and 3,125 households with disabled old adults and their home-bound caregivers were eventually selected for this analysis. Regression methods and mediation analysis methods were employed in this study.

Results

The results indicated that there was a significant positive association between caring load and the caregiver burden, and specifically, social support intensity (rather than social support breadth) and passive social exclusion (rather than active social exclusion) played partial mediating effects. Furthermore, the contributions of mediating effects of social support intensity and passive social exclusion were 13-15 and 27-29%, respectively, and the total contribution of mediating effects was about 35-38%.

Conclusion

Family caregivers' burden should be paid more attention to in the large population with rapidly aging speed like China, and more guidance services as well as support should be provided to family caregivers. In addition, it is crucial to focus on the community's social support and social exclusion in public policy innovation.

Anticipatory Burden in Adult-Child Caregivers: A Concept Analysis

This study aims to analyze the concept of anticipatory burden in adult-child caregivers. A systematic literature review was performed using four databases, Pubmed, CINAHL, PsycINFO and Medline, with the keywords of “anticipatory burden” and “anticipated burden”. Simplified Wilson’s classic concept analysis modified by Walker and Avant was employed to identify the attributes, antecedents and consequences of anticipatory burden in the adult-child caregivers. Eighteen articles were analyzed. Attributes of anticipatory burden in adult-child caregivers were found to be: (1) subjective burden, (2) anticipation, (3) overestimation, (4) inability, and (5) family relationship. Antecedents were identified as: (1) potential care recipients, (2) caregiving willingness, and (3) a lack of resources. Consequences included: (1) prediction of caregiving willingness, (2) impacts on caregivers’ health, (3) intervention promotion, and (4) behavioral changes. As the adult-child caregiver is one of the main types of family caregivers for the fast-growing aging population, it is important to understand the attributes, antecedents, and consequences of their anticipatory burden. Based on the results of this study, resources such as intervention, policy, and counseling services are recommended to help adult-child caregivers lower their anticipatory burden and get better prepared for providing family care.

Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum

Articles dealing with late-presenting congenital diaphragmatic hernia (CDH) in children published until 2003 were collectively reviewed. The main purpose of the presented study was to gain insight into the clinical spectrum of this variant of CDH and to discuss its clinical and surgical aspects. In 125 articles, 362 patients were reported. Left posterolateral hernia was the dominant anatomical type, found in 79.4% of the children. Male-to-female distribution was nearly 2:1 in both right- and left-sided CDH. Associated anomalies were noted in 8.6% of children. Sixty-five percent of children with right CDH presented within the 1st year of life, whereas only 41.7% of patients with left CDH belonged to this age group. The children with right CDH presented with chronic symptoms in 57.4% of cases, while among those with left CDH, acute presentation prevailed, constituting 60.5% of this group. No strict correlation between age and clinical symptoms was noted, although the youngest patients tended to present with respiratory symptoms. Late-presenting diaphragmatic hernia is associated with a wide range of clinical symptoms occurring in various constellations. Dyspnea and vomiting were the most frequent symptoms found in patients with either chronic or acute manifestation. Preoperative mortality was 3.9% (14 children). In 45 children (12.4%), complications resulting from diaphragmatic hernia were noted, and in a further 11 children iatrogenic preoperative complications were noted. Among 152 children with reported CDH, true hernia with sac was found in 32.7%. Eight children (2.2%) died in the early postoperative period, while a further 13 patients (3.6%) had postoperative complications requiring surgical management. Recurrence of hernia was noted in seven children (1.9%). This collective review of basic epidemiological and clinical data from a large group of patients seems to support a hypothesis for a congenital nature of the diaphragmatic defect and an acquired nature of "herniation" of the viscera. The wide clinical spectrum of late-presenting CDH seems to be conditioned by two factors: timing of herniation and type of intraabdominal viscera displaced into the chest.

Caregiver burden: a concept analysis

The development of the concept of burden for use in research lacks consistent conceptualization and operational definitions. The purpose of this article is to analyze the concept of burden in an effort to promote conceptual clarity. The technique advocated by Walker and Avant is used to analyze this concept. Critical attributes of burden include subjective perception, multidimensional phenomena, dynamic change, and overload. Predisposing factors are caregiver's characteristics, the demands of caregivers, and the involvement in caregiving. The consequences of burden generate problems in care-receiver, caregiver, family, and health care system. Overall, this article enables us to advance this concept, identify the different sources of burden, and provide directions for nursing intervention.

Medical Research Council Clinical Psychiatry Unit

The Clinical Research Department was started at Graylingwell Hospital, Chichester, Sussex, by Dr. J. Carse in 1947, when the hospital was administered by Sussex County Council. The first director was Dr. (now Professor) E. Stengel, and he undertook the first systematic follow-up of leucotomized patients. From 1950 to 1955 the director was Dr. Martin Roth; his studies on the psychoses of old age, and especially those delineating depressive psychoses, are now a landmark in clinical research. At about this time, the means by which clinical research in the National Health Service hospitals should be administered was reviewed and a policy evolved whereby departments in which clinical research was prospering and whose further development would make financial demands beyond those available to the regional hospital boards would be considered for support by the Medical Research Council.

Suicide and community care

In recent years there has been a considerable shift towards the treatment of psychiatric patients outside hospital; and although progress in the expansion of such services as hostels, day centres and social work has in many places been slow, the idea of a Community Service based on home care whenever possible has become a popular one and forms the basis of official planning in this country (16). Doubts have, however, been expressed as to the wisdom of so great an emphasis on this untried method of management (13, 34, 39); the proper evaluation of Community Care is therefore of great importance.