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Nguyen HT, Nguyen PTN, Lin CK, Do PM. Association between quality of life and burden of cancer caregivers: An example in a low and middle income country. Eur J Oncol Nurs 2024; 70:102596. [PMID: 38805952 DOI: 10.1016/j.ejon.2024.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Limited knowledge on burden and quality of life (QoL) among cancer caregivers is available in low and middle income countries. This study aims to investigate the QoL, levels of burden, and their associations among Vietnamese cancer caregivers. METHODS This study was conducted across three hospitals in Vietnam. 348 caregivers were recruited from January to June 2021. Data were collected by using socio-demographic questionnaires, the Zarit Burden Interview scale, and Caregiver Qol Cancer. The association between QoL and burden was analyzed by using multivariate linear regression. RESULTS Older age (p = 0.03), employed (p = 0.01), and care more than 40 h (p = 0.007) were associated with a higher burden, respectively. QoL of financial concern had the lowest score (mean = 48.03, SD = 28.87), compared to the other subscale. Caregivers who had pre-existing health conditions, unstable work, spent more than 40 h per week, and took care dependent cancer patients were associated with a lower overall QoL score. Comparing to caregivers of no burden, those of mild burden had a lower QoL score by 10.70; while those of mild severe burden had the worse QoL (lower by 23.80 scores). CONCLUSIONS Perceptional burden among caregivers is associated with QoL. Further policies are recommended to protect cancer caregivers, to alleviate the caregiving burden, and thus to improve the overall QoL.
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Affiliation(s)
- Hien Thi Nguyen
- Nursing Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam; School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | | | - Cheng-Kuan Lin
- National Yang Ming Chiao Tung University, International Health Program, College of Medicine, Taiwan; National Yang Ming Chiao Tung University, Institute of Public Health, Taiwan.
| | - Phuong Minh Do
- Nursing Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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2
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Ilaghi M, Gharib F, Pirani A, Vahabie AH, Grafman J, Shariat SV, Shariati B, Jahanbakhshi A, Mirfazeli FS. The burden of traumatic brain injury on caregivers: exploring the predictive factors in a multi-centric study. BMC Psychol 2024; 12:150. [PMID: 38491536 PMCID: PMC10941615 DOI: 10.1186/s40359-024-01652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide. With survivors often exhibiting degrees of function loss, a significant burden is exerted on their caregivers. The purpose of this study was to explore the predictive factors of caregiver burden among caregivers of patients with TBI. METHODS Sixty-eight family members of individuals with a TBI who had been admitted to three hospitals were assessed in terms of caregiver burden using the Zarit Burden Interview. The association of caregiver burden with patients' baseline cognitive function according to the Montreal Cognitive Assessment (MoCA) test, as well as caregivers' sociodemographic characteristics, were evaluated using multiple regression analysis. RESULTS Based on the multiple regression model, the MoCA score of the patients (std β=-0.442, p < 0.001), duration of caregiving (std β = 0.228, p = 0.044), and higher education of the caregivers (std β = 0.229, p = 0.038) were significant predictors of caregiver burden. CONCLUSION Overall, our findings highlight the importance of taking caregivers' psychosocial needs into account. Long-term caregivers of TBI patients with cognitive impairment should be viewed as vulnerable individuals who could benefit from psychosocial intervention programs, to improve their well-being and enabling them to enrich their care of the TBI patient.
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Affiliation(s)
- Mehran Ilaghi
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farhad Gharib
- Mental Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pirani
- Mental Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdol-Hossein Vahabie
- School of Electrical and Computer Engineering (ECE), College of Engineering, University of Tehran, Tehran, Iran
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Jordan Grafman
- Shirly Ryan AbilityLab, Departments of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology, and Alzheimer's Center, Chicago, IL, USA
- Department of Psychiatry, Feinberg School of Medicine, Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Seyed Vahid Shariat
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Amin Jahanbakhshi
- Skull Base Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
- National Brain Centre, Iran University of Medical Sciences, Tehran, Iran.
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Brady S. New Role, New Paycheck: The Impact on Women's Wages When Becoming a Caregiver for an Aging Parent. Res Aging 2024; 46:197-209. [PMID: 37977132 DOI: 10.1177/01640275231217297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Objectives: While prior research demonstrates the negative impacts of adult caregiving on women's employment, less research examines how women's employment changes when beginning a new caregiving role. Methods: Using data from eight waves of the Health and Retirement Study (2004-2018), I examine changes in women's employment when first transitioning into parental caregiving between the ages of 50-60, by analyzing changes in labor force participation, work hours, and hourly wages. Results: The transition into parental caregiving was not associated with women exiting the workforce or decreasing their work hours. However, caregivers did experience a decrease in inflation-adjusted hourly wages compared to non-caregivers, with the greatest wage penalties associated with high-intensity caregiving situations. Conclusion: Results demonstrate how parental caregiving may act as a shock to women's financial health at a critical career stage. This study highlights the less visible, but detrimental, financial consequences women experience when taking on a family caregiving role.
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Affiliation(s)
- Samantha Brady
- Department of Sociology, Brown University, Providence, RI, USA
- AgeLab, Massachusetts Institute of Technology, Cambridge, MA, USA
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Subramaniam A, Mehta KK. Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:182. [PMID: 38397673 PMCID: PMC10888348 DOI: 10.3390/ijerph21020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.
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Affiliation(s)
- Araviinthansai Subramaniam
- S R Nathan School of Human Development, Singapore University of Social Sciences, Singapore 599494, Singapore;
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Chao ML, Tseng YH, Chen YM, Chiang TL. Relationship Between Multiple Roles and Leisure-Time Physical Activities in Working-Age Women. J Nurs Res 2024; 32:e313. [PMID: 38190325 DOI: 10.1097/jnr.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Multiple role theory has proven effective in predicting variations in health, and a growing body of research has shown the importance of taking women's roles into account when analyzing physical activity levels. Nonetheless, researchers have yet to characterize the interaction between the various roles played by women and their physical activity. PURPOSE The objectives of this study were to elucidate the relationship between multiple roles and leisure-time physical activities (LTPAs) and to determine whether LTPA varies among women across different roles. METHODS Data were derived from the 2013 National Health Interview Survey database provided by the Health Promotion Administration of Taiwan's Ministry of Health and Welfare, which includes 5,147 working-age women. The current study focused on women aged 20-50 years. The roles considered in this study included living with a partner, living with children, and employment status. LTPA levels were categorized as regular, inactive, or insufficient based on the LTPA metabolic equivalent in the previous week. The associations among level of LTPA, multiple roles, and demographic characteristics were analyzed using multiple regression analysis. RESULTS We found single mothers with children to be more inactive than partnered mothers, and women living with a partner and those living with children were more likely to be inactive, whereas women working full-time were not at risk of inactivity. Women who assumed a larger number of roles were at a greater risk of inactivity. These findings are consistent with role strain theory. CONCLUSIONS Single mothers with children are more inactive than partnered mothers, and appropriate social support programs are necessary to reduce further disparities. Second, multiple demands on working-age women limit the time available for LTPAs, particularly among women living with a partner and children and engaged in full-time work. A physical activity intervention is a program or initiative designed to promote physical activity and improve health outcomes. We should develop and provide sustainable physical activity resources through the help of partners' housework to better promote physical activity intervention for working-age women.
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Affiliation(s)
- Mei-Ling Chao
- PhD, RN, Assistant Professor, College of Nursing, Meiho University, Taiwan
| | - Yu-Hwei Tseng
- PhD, Assistant Professor, Department of Public Health, College of Medicine, National Cheng Kung University, Taiwan
| | - Ya-Mei Chen
- PhD, Professor, Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
| | - Tung-Liang Chiang
- PhD, Professor, Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan
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Carson A. A Pressure Release Valve: South Korean Long-Term Care Policy as Supplemental to Family Elder Care. J Aging Soc Policy 2023; 35:756-779. [PMID: 36242768 DOI: 10.1080/08959420.2022.2133318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
South Korea's National Long-term Care Insurance (NLTCI) has received international acclaim for its universal continuum-of-care model. Based on 25 qualitative interviews with family caregivers, this research explores the relationship between NLTCI policies and experiences of family caregiving for older people. Caregivers who share care responsibilities or are supported by other family are coping well with minor to moderate policy recommendations. Lone caregivers without support from other family are struggling and express desire for expanded services. These findings highlight a need for more consideration of the influence of family dynamics on informal caregiver burdens. Despite many strengths, NLTCI policy functions as a pressure release valve, supplementing family care for seniors - not replacing it - with minimal gender equity contributions.
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Affiliation(s)
- Alexa Carson
- PhD Candidate, Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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Li KK, Leung CLK, Yeung D, Chiu MYL, Chong AML, Lam BCY, Chung EKH, Lo TW. Development and validation of the caregiver needs and resources assessment. Front Psychol 2023; 14:1063440. [PMID: 37008844 PMCID: PMC10064064 DOI: 10.3389/fpsyg.2023.1063440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
IntroductionExisting caregiver assessment tools were long criticized for focusing on the needs and burden while neglecting the importance of the resources. The current study aimed to develop a multidimensional and time-effective assessment tool that measures both needs and resources of non-paid family caregivers of older adults for screening and service-matching purposes.MethodsItems of the Caregiver Needs and Resources Assessment (CNRA) were developed from extensive literature reviews and focus group interviews of family caregivers and social workers in the field. In addition, we collected 317 valid responses from family caregivers of older adults from local non-government organizations in examining the psychometric properties of the CNRA.ResultsThe results revealed a 12-factor structure that fitted nicely into the conceptual frame of needs and resources domains. Need factors were positively associated with mental health symptoms, while resource factors were positively associated with peace in mind, meaning-making, and personal gain measures. The 36-item CNRA revealed good internal reliability and convergent validity.DiscussionThe CNRA has the potential to be used as a compact yet balanced assessment tool for understanding both the needs and resources of caregivers for human service professionals.
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Affiliation(s)
- Kin-Kit Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- *Correspondence: Kin-Kit Li,
| | - Cyrus L. K. Leung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Cyrus L. K. Leung,
| | - Dannii Yeung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Marcus Y. L. Chiu
- School of Health and Wellbeing, University of Bolton, Bolton, United Kingdom
- Centre for Mental Health and Society, Bangor University, Bangor, United Kingdom
| | - Alice M. L. Chong
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Beck C. Y. Lam
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Edwin K. H. Chung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - T. Wing Lo
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Caritas Institute of Higher Education, Tseung Kwan O, New Territories, Hong Kong SAR, China
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8
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Turner SG, Epps F, Li M, Leggett AN, Hu M. Validation of a Measure of Role Overload and Gains for End-of-Life Dementia Caregivers. J Gerontol B Psychol Sci Soc Sci 2023; 78:S15-S26. [PMID: 36409299 PMCID: PMC10010474 DOI: 10.1093/geronb/gbac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Caregiving stress process models suggest that heterogeneous contexts differentially contribute to caregivers' experiences of role overload and gains. End-of-life (EOL) caregivers, especially EOL dementia caregivers, facing unique challenges and care tasks, may experience role overload and gains in different ways than other caregivers. This study evaluates measurement invariance of role overload and gains between EOL caregivers and non-EOL caregivers and between EOL dementia and EOL non-dementia caregivers. METHODS We utilized role gains and overload data from 1,859 family caregivers who participated in Round 7 of the National Study of Caregiving. We ran confirmatory factor analyses to investigate the factorial structure across all caregivers and then examined the structure's configural, metric, and scalar invariance between (a) EOL caregivers and non-EOL caregivers and (b) EOL dementia and EOL non-dementia caregivers. RESULTS Across the entire sample, the two-factor overload and gains model had good fit (χ 2(19) = 121.37, p < .0001; RMSEA = .053, 90% CI = [.044, .062]; CFI = .954; TLI = .932). Tests of invariance comparing EOL caregivers to non-EOL caregivers and EOL dementia caregivers to EOL non-dementia caregivers maintained configural, metric, and partial scalar invariance. Latent mean comparisons revealed that EOL caregivers had higher role overload (p = .0002), but no different role gains (p = .45), than non-EOL caregivers. Likewise, EOL dementia caregivers had higher role overload (p = .05), but no different role gains (p = .42), than EOL non-dementia caregivers. DISCUSSION Results offer both a deeper theoretical understanding of end-of-life dementia caregivers' experiences of role overload and gains, and a practical tool to measure those experiences.
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Affiliation(s)
- Shelbie G Turner
- School of Social and Behavioral Health, Oregon State University, Corvallis, Oregon, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amanda N Leggett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mengyao Hu
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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9
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Zeng Y, Mao S, Lu N, Chen M. Activity Patterns and Loneliness in Later Life: The Mediating Effects of Social Support and Attitudes Toward Aging. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:303-318. [PMID: 35880465 DOI: 10.1080/01634372.2022.2103761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Studies have documented the inconsistent influences of activity participation on health. However, the underlying mechanisms connecting activity patterns to loneliness are relatively understudied. Using data on 8,545 respondents aged 60 or older from the 2014 China Longitudinal Aging Social Survey, we used latent class analysis to identify the patterns of participating in eight activities and path analysis to examine the mediating effects of formal support, informal support, and aging attitudes in the relationship of activity patterns and loneliness. Three meaningful patterns of activity (high activity, low activity, and working caregivers) were identified. Working caregivers and low activity groups, compared to high activity, showed higher levels of loneliness in later life. Informal support, rather than formal support, and attitudes toward aging mediated the relationship between activity patterns and loneliness in later life. This study highlights the importance of fuller engagement in diverse political, economic, and community activities to prevent loneliness. Additionally, intervention programs that facilitate joint support from family, community, and government and shape scientific understanding of aging are critical for alleviating loneliness in later life.
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Affiliation(s)
- Yue Zeng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Shan Mao
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Meng Chen
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, Beijing, China
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Koreshi SY, Alpass F. Understanding the use of Flexible Work Arrangements Among Older New Zealand Caregivers. J Appl Gerontol 2023; 42:1045-1055. [PMID: 36639985 PMCID: PMC10088344 DOI: 10.1177/07334648231152153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Flexibility in the workplace has been suggested to promote prolonged employment among older workers. This study focuses on the question of whether the use of flexible work arrangements (FWAs) differs between caregivers and non-caregivers and how potential differences can be explained. Participants were 296 carers and 1611 non-carers (aged 55-70 years) who completed the 2018 Health, Work and Retirement survey and were in paid employment. Hierarchical regression was used to investigate caregiving as an independent predictor of use of FWAs after controlling for demographic and work-related variables. Results show that caregivers on average used more FWAs than non-caregivers, including flexible work hours, flexible schedules and time off. Differences in FWAs use between caregivers and non-caregivers cannot be explained by differences in socio demographic and work characteristics. The use of FWAs warrants attention in discussions about prolonged employment and reconciliation of care and work among older adults.
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Affiliation(s)
| | - Fiona Alpass
- 6420Massey University, Palmerston North, New Zealand
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Alcover CM, Fernández-Salinero S, Topa G, Desmette D. Family Care-Work Interference and Mid/Late-Career Motivation and Intentions: Mediating Role of Occupational Future Time Perspective. JOURNAL OF CAREER DEVELOPMENT 2022. [DOI: 10.1177/08948453221124895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The combination of work and family obligations can lead to two-way interference, resulting in Family Care Interference with Work (FCIW) and Work Interference with Family Care (WIFC). Both can impact late career motivation and intentions to continue working or retire and reduce their occupational time perspective (OFTP). Through two studies, this paper shows how OFTP mediates the relationship between FCIW/WIFC and mid and late career indicators such as early retirement intentions and motivation to continue working beyond the retirement age. Our findings contribute to increasing knowledge of how increasing family caregiving obligations may impact the career intentions of working carers in their mid and late career stages.
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Affiliation(s)
| | | | - Gabriela Topa
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Donatienne Desmette
- Psychological Sciences Research Institute, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
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Shorey S, Ng ED. A Social-Ecological Model of Grandparenting Experiences: A Systematic Review. THE GERONTOLOGIST 2022; 62:e193-e205. [PMID: 33146711 DOI: 10.1093/geront/gnaa172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Grandparenting trends have been increasing due to rises in female employment, economic stressors, and single-parent families. Because the level of grandparental involvement could either result in beneficial or adverse physical and mental health outcomes, this review aims to use a social-ecological model to compare the childcare experiences of primary and nonprimary grandparent caregivers and the effects of childcare on their physical and emotional health. RESEARCH DESIGN AND METHODS This is a systematic review. CINAHL, Embase, PsycINFO, PubMed, and Scopus were searched for qualitative papers. A thematic analysis was conducted, and data were framed using the social-ecological model. RESULTS Seventy-four qualitative studies were included. Four themes were generated: intrapersonal: attitudes and motivations (obligation and sense of responsibility, limited physical health, and emotional resources), interpersonal: relationships with grandchildren and adult children (grandparental roles and gendered differences, forging bonds with grandchildren, role ambiguities, conflicts and drawing boundaries, and support and relationships with others), organizational: social services and educational needs, and policy: financial and legal issues. Grandparental well-being is likely to be dependent on the context of the childcare provided, relational bonds with adult children and grandchildren, and the availability of a community and institutional, legal, and financial support. DISCUSSION AND IMPLICATIONS The act of grandparenting is laden with cost and reward. To ensure a better quality of life in grandparents' later years, joint efforts between policymakers, educators, and organizations are required to meet their childcare support needs such that they can fulfill their grandparenting roles with ease.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Smith G, Rodham K. Supporting and sustaining care at home: Experiences of adult daughters who support a parent with dementia to remain in their own home. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:81-90. [PMID: 33825265 DOI: 10.1111/hsc.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Supporting a parent with dementia living in their own home is a challenging care issue which has potential for negative physical, emotional and psychosocial impacts. This research explores the experiences of adult daughters who sustain this arrangement as well as managing the competing demands of their lives. Using a qualitative approach, semistructured interviews were conducted between March and October 2017. Eight adult females in the United Kingdom who were supporting a parent with dementia to remain living in their home were interviewed. Photo-elicitation was used as an aid to data collection and complemented the use of Thematic Analysis (TA) to analyse verbatim transcripts. Four themes were identified: (a) Impact on identity: impact of the participants' experience on their sense of identity; (b) Continuity and change: relationship redefinition and duality of roles; (c) Stepping up to the challenge: adjustment to and coping with competing demands and ethical dilemmas; and (d) Finding help: 'It is just a minefield': experiences of help-seeking and service provision. This study highlights the experiences and challenges for adult daughters who support a parent with dementia. Ethical dilemmas regarding autonomy and safeguarding concerns figure large along with the competing demands of multiple roles. Service providers should aim to be more proactive in offering timely practical and psychosocial support and guidance to avoid compassion fatigue and acknowledge the valuable unpaid service provided by these 'women in the middle'.
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Affiliation(s)
- Gillian Smith
- Staffordshire Centre for Psychological Research, Department of Psychology, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Karen Rodham
- Staffordshire Centre for Psychological Research, Department of Psychology, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Pattison A, Torres E, Wieters L, Waldschmidt JG. A comparison of caregiver burden between long-term care and developmental disability family caregivers. J Res Nurs 2021; 26:781-793. [DOI: 10.1177/17449871211024325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background As the United States’ population ages and health concerns rise, the family caregiver occupation will continue to be an integral part of the health care system. Aims It is important to examine the burden that family caregivers experience so they can seek out additional training and services to maintain their own well-being. The researchers examined caregiver burden from a perspective of developmentally disabled and long-term care. Methods The researchers examined difference in Zarit scores, guilt, burden and personal strain for 72 caregivers of people with developmental disability (DD) or people with long-term care (LTC) needs. The researchers also examined differences in these based on whether the individual was caregiving for family or “others”. Results For DD, there were significant differences in Zarit, role strain and personal strain; caring for others has significantly lower scores on these. Role strain was significantly higher than personal strain, which was significantly higher than guilt for both LTC and DD groups. Conclusions Given these findings, it is important to support family caregivers first and foremost with role strain, especially for those caring for family members with DD. This support could be given through personal counselling, caregiver training, non-profit social service resources, and support groups for family caregivers.
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Affiliation(s)
- Alison Pattison
- Associate Adjunct Professor and Senior Doctoral Adjunct Chair, The College of Doctoral Studies, Grand Canyon University, USA
- Founder and CEO, Arizona Provider Training, USA
| | | | - Lori Wieters
- Industrial/Organisational Psychologist, Grand Canyon University, USA
- Owner of the Wi2 Co-Lab, Arizona Provider Training, USA
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Vara-García C, Romero-Moreno R, Barrera-Caballero S, Pedroso-Chaparro MDS, Cabrera I, Márquez-González M, Olazarán J, Losada A. Personal values profiles in dementia family caregivers: their association with ambivalent feelings and anxious and depressive symptoms. Aging Ment Health 2021; 25:2160-2168. [PMID: 32954792 DOI: 10.1080/13607863.2020.1821169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Culture-related variables, such as personal values, have been suggested as important in stress processes, such as family caregiving of people with dementia. Personal values may be categorized into two dimensions: family and own personal values. Drawing upon the Sociocultural Stress and Coping model, the objective of this study is to analyze differences between caregivers depending on their values profiles. METHOD Participants were 333 family caregivers of a spouse or a parent with dementia. Caregivers chose their two most important values, apart from caregiving, from a list of eight family-related and non-family-related values (own values). Therefore, three values profiles were possible: Family-values profile (FVP: the two values are family related), Mixed-values profile (MVP: one family related value and one own value), and Own-values profile (OVP: two own values were selected). In addition to values, sociodemographic variables, commitment and satisfaction with caregiving value and with chosen values, ambivalent feelings, and anxiety and depression symptomatology were assessed. ANOVA analyses were conducted. RESULTS The analyses suggest that caregivers in the FVP had lower levels of anxiety and ambivalent feelings and a higher commitment to and satisfaction with their chosen values than the other profiles. No differences were found for commitment and satisfaction with the caregiving value. CONCLUSION Caregivers' value profiles seem to play an important role in the effects of stress over psychological health. Possible explanations of these effects about potential role conflicts and a higher commitment to values are discussed.
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Affiliation(s)
| | | | | | | | - Isabel Cabrera
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Department of Neurology, Hospital Gregorio Marañón, Madrid, Spain
| | - Andrés Losada
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Spain
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Morimoto H, Takebayashi Y. Antecedents and Outcomes of Enrichment Among Working Family Caregivers of People With Dementia: A Longitudinal Analysis. J Gerontol B Psychol Sci Soc Sci 2021; 76:1060-1070. [PMID: 33099602 PMCID: PMC8200353 DOI: 10.1093/geronb/gbaa183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives Despite evidence of negative aspects of the work–caregiving interface (e.g., work–family conflict) among family caregivers of people with dementia (PWD), little is known about the positive aspects (e.g., enrichment). We examined antecedents and outcomes of family-to-work enrichment (FWE) and work-to-family enrichment (WFE) among working family caregivers of PWD. In terms of antecedents, we investigated whether factors that alleviated work–family conflict increased enrichment. Method We conducted a 3-wave 6-month-interval longitudinal online survey of Japanese working family caregivers of PWD (N = 747). We examined the mediational effects of WFE and FWE on associations between participants’ work resources (job control, supervisor support, co-worker support, and organizational support) and caregiving support and their well-being (psychological distress and quality of life). We also examined the moderating effect of caregiving self-efficacy on the relationships between caregiving support/caregiving demands and FWE. Results Our longitudinal analysis confirmed supervisor support had a positive effect on WFE. FWE had no significant longitudinal mediating effect on the association between caregiving support and well-being, and self-efficacy had no longitudinal moderating effect on FWE. Discussion Supervisor support is important for WFE, but greater enrichment does not necessarily improve family caregiver well-being. Caregiving experience (i.e., caregiving demands and caregiving support) has little effect on the work–caregiving interface. Policy makers should focus on supporting companies to create family-friendly work environments. More research is needed on factors that increase FWE and moderate the relationship between enrichment and working family caregivers’ well-being.
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Factors associated with informal caregiving and its effects on health, work, and social activities of adult informal caregivers in Malaysia: findings from the National Health and Morbidity Survey 2019. BMC Public Health 2021; 21:1033. [PMID: 34074275 PMCID: PMC8170800 DOI: 10.1186/s12889-021-11022-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background The increase in the elderly population, chronic and degenerative diseases, as well as accidents at work and on the road in Malaysia would result in an increased demand for informal care. This paper aimed to determine the associated factors of informal caregiving and its effects on health, work and social activities of adult informal caregivers in Malaysia. Methods The data from the 2019 National Health and Morbidity Survey (NHMS), a nationwide cross-sectional survey with a two-stage stratified random sampling design, was used in this research. The study included respondents who were 18 years and older (n = 11,674). Data were obtained via face-to-face interviews using validated questionnaires. Descriptive and complex sample logistic regression analyses were employed as appropriate. Results 5.7% of the adult population were informal caregivers. Provision of informal care were significantly associated with the female sex (OR = 1.52, 95% CI [1.21, 1.92]), those aged 36–59 years (OR = 1.61, 95% CI [1.15, 2.25]), and those who reported illness in the past 2 weeks (OR = 1.79, 95% CI [1.38, 2.33]). The risk of having their health affected were associated with female caregivers (OR = 3.63, 95% CI [1.73, 7.61]), those who received training (OR = 2.10, 95% CI [1.10, 4.00]) and those who provided care for 2 years or more (OR = 1.91, 95% CI [1.08, 3.37]). The factors associated with the effects on work were ethnicity, received training and had no assistance to provide the care. In terms of effect on social activities, female caregivers (OR = 1.96, 95% CI [1.04, 3.69]) and caregivers who received training were more likely (OR = 2.19, 95% CI [1.22, 3.93]) to have their social activities affected. Conclusion Our study revealed that sex, age, and self-reported illness were factors associated with being an informal caregiver in Malaysia. Informal caregivers faced effects on their health, work, and social activities which may be detrimental to their well-being. This understanding is crucial for planning support for caregivers.
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Infurna FJ, Gerstorf D, Lachman ME. Midlife in the 2020s: Opportunities and challenges. ACTA ACUST UNITED AC 2021; 75:470-485. [PMID: 32378943 DOI: 10.1037/amp0000591] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Development is a cumulative, lifelong process, but strikingly little is known about development in midlife. As a consequence, many misconceptions exist about the nature of midlife and the developmental milestones and challenges faced by middle-aged adults. We first review dominant views and empirical research that has debunked false narratives. Next, we discuss major opportunities and challenges of midlife. This includes the unique constellation of roles and life transitions that are distinct from earlier and later life phases as well as shifting trends in mental and physical health and in family composition. We additionally highlight the importance of (historical shifts in) intergenerational dynamics of middle-aged adults with their aging parents, adult children, and grandchildren; financial vulnerabilities that emerge and often accrue from economic failures and labor market volatility; the shrinking social and health care safety net; and the rising costs of raising children. In doing so, we discuss issues of diversity and note similarities and differences in midlife experiences across race or ethnicity, sexual orientation, and socioeconomic status. We consider midlife as a pivotal period that includes a focus on balancing gains and losses, linking earlier and later life periods, and bridging generations. Finally, we propose possibilities for promoting reversibility and resilience with interventions and policy changes. The suggested agenda for future research promises to reconceptualize midlife as a key period of life, with a concerted effort to focus on the diversity of midlife experiences in order to meet the unprecedented challenges and opportunities in the 2020s and beyond. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Views and experiences of adult children concerning intergenerational relationships with their older kin: a qualitative study from South India. AGEING & SOCIETY 2021. [DOI: 10.1017/s0144686x21000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The tradition of intergenerational care and support exchanges in Indian families is assumed to be disturbed because of changes in family structure brought on by modern life, which is mainly based on studies investigating experiences of older adults regarding the impact of socio-economic change on their care arrangement. However, there is a large gap in understanding the experiences of adult children from a larger relational perspective, more than just care provision to their older relatives. Drawing on 26 in-depth interviews with adult children living in modern and traditional living arrangements from South India, the study explores their experiences with their parents with regard to reciprocity of care and support, the challenges they experience and strategies they adopt to overcome those challenges. The analysis shows adult children perceive the increased demands of modern work life and their older kin's preferences to be heard, lack of flexibility and related extra domestic work and costs, do cause a bigger burden for them in both living arrangements. However, adult children strive to uphold the traditional values of caring for their older kin and sharing emotional bonding with them. This inspiration helps them to employ strategies to accept their older relatives as they are, focus their attention on the benefits they receive from them and distribute care tasks with other relatives to overcome the challenges.
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20
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Sakka M, Kita S, Sato I, Soejima T, Eguchi H, Tokita M, Yamamoto-Mitani N, Shimazu A, Kamibeppu K. Reliability and validity of the Japanese version of the Caregiving Interface Work Scale in employed Japanese family caregivers. Geriatr Gerontol Int 2020; 21:254-261. [PMID: 33319458 DOI: 10.1111/ggi.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/28/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to develop a Japanese version of the Caregiving Interface Work Scale (J-CIWS) for use with employed Japanese family caregivers. METHODS Permission was obtained from the developer of the original CIWS. The CIWS contains 20 items: 10 measuring care interface work (CIW) and 10 measuring work interface care (WIC). Responses are measured on a five-point Likert scale. The J-CIWS was developed through forward- and back-translation and cognitive interviews of employed family caregivers. An internet survey was conducted with 116 employed family caregivers, and 78 participants answered a retest. Questionnaire items included the J-CIWS and demographic factors. Factor analysis was conducted to determine the J-CIWS factor structure. Validity was assessed based on known-groups, convergent and discriminant validity. Internal consistency was examined by calculating Cronbach's α. Test-retest reliability was examined by calculating the Pearson's correlation coefficient. RESULTS The mean participant age was 50.3 years; 74 (63.8%) were male. The average weekly working and caregiving hours were 41.6 and 12.1 h, respectively. Confirmatory factor analysis supported the original two-factor model. High internal consistency (Cronbach's alpha >0.90) and sufficient test-retest reliability (weighted κ score >0.45) were demonstrated for both subscales. Convergent and discriminant validity were acceptable for the two subscales (CIW and WIC). CONCLUSIONS This study confirmed the usefulness of the CIWS within a Japanese context. The J-CIWS may be useful for evaluating the extent of the conflict between work and care among employed family caregivers. Geriatr Gerontol Int 2021; 21: 254-261.
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Affiliation(s)
- Mariko Sakka
- Department of Gerontological Home-Care & Long-term Care Nursing Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takafumi Soejima
- Department of Family Nursing, Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisashi Eguchi
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masahito Tokita
- The Keio Research Institute at SFC, Keio University, Fujisawa, Japan
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home-Care & Long-term Care Nursing Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Shimazu
- Faculty of Policy Management, Keio University, Fujisawa, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Graduate School of Health Sciences & Nursing, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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21
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Kayaalp A, Page KJ, Rospenda KM. Caregiver Burden, Work-Family Conflict, Family-Work Conflict, and Mental Health of Caregivers: A Mediational Longitudinal Study. WORK AND STRESS 2020; 35:217-240. [PMID: 34483432 DOI: 10.1080/02678373.2020.1832609] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Caregivers are responsible for the care of another, such as a young adult, disabled child, elderly parent, or sick spouse. Individuals who have caregiving responsibilities must blend the often-contradictory behavioral expectations from the different roles in which they reside. Building on the theoretical foundations of Conservation of Resources theory, this study tests a mediational model explicating the process through which caregiver burden impacts mental health through work-family conflict among a community sample of 1,007 unpaid caregivers in the greater Chicago area who responded to a mail survey at three time points. Structural equation modeling analyses indicate strain-based conflict as being a consistent mediator between caregiver burden and mental health at baseline and two years later. These findings can inform practice and policy for workers with caregiving responsibilities.
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Affiliation(s)
- Alper Kayaalp
- Department of Psychology, South Dakota State University, 857 11th St., 029B Hansen Hall, Brookings, SD 57007
| | - Kyle J Page
- American Family Insurance, 6000 American Parkway, Madison, WI 53783
| | - Kathleen M Rospenda
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612
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22
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Kong J, Martire LM, Tate AM, Bray BC, Almeida DM. Different Types of Childhood Experience with Mothers and Caregiving Outcomes in Adulthood. FAMILY RELATIONS 2020; 70:1090-1101. [PMID: 34650318 PMCID: PMC8514082 DOI: 10.1111/fare.12511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE AND BACKGROUND The current study examines the types of childhood experiences with mothers (i.e., maternal abuse, affection, discipline) among caregivers of aging mothers, and investigates whether membership in specific latent classes, particularly maternal maltreatment, is associated with psychological functioning among caregivers. METHOD Using data from the Midlife in the United States (MIDUS), we used the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA) to predict distal outcomes. RESULTS We identified four latent classes (prevalence rate noted): "Affectionate and authoritative" (65%), "affectionate and permissive" (11%), "emotionally abusive and neglectful" (8%), and "emotionally/physically abusive and authoritative" (16%). Caregivers in the "emotionally/physically abusive and authoritative" class endorsed high probabilities of both maternal affection and abuse and were most negatively affected across the three psychological functioning outcomes (i.e., self-rated mental health, psychological distress, and psychological well-being). CONCLUSION AND IMPLICATIONS In support of the life course perspective, our findings emphasized the importance of examining adult children caregivers' early life experiences with aging mothers and how those experiences can impact the psychological effects of caregiving. This study suggests specific practice implications; for example, assessment tools for evaluating caregiver burden should consider life course factors such as caregivers' childhood experiences with aging parents.
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Affiliation(s)
- Jooyoung Kong
- School of Social Work, University of Wisconsin-Madison, 1350 University Avenue, Madison, WI 53706
| | - Lynn M Martire
- Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802
| | - Ashley M Tate
- Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802
| | - Bethany C Bray
- Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL 60607
| | - David M Almeida
- Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802
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23
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Ding R, Dardas A, Wang L, Williams A. Evaluation of a Caregiver-Friendly Workplace Program Intervention on the Health of Full-Time Caregiver Employees: A Time Series Analysis of Intervention Effects. J Occup Environ Med 2020; 62:e548-e558. [PMID: 32769780 PMCID: PMC7537735 DOI: 10.1097/jom.0000000000001980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate effectiveness of a workplace educational intervention at improving health-related outcomes in carer-employees. METHODS A pre-post test design compared with health of a sample (n = 21) of carer-employees before (T1) and after (T2) a workplace intervention, as well as a final timepoint (T3) 12 months after T1. An aggregate health score was used to measure health and consisted three scales; depression (CES-D), psychosocial (CRA), and self-reported health (SF-12), where higher scores indicated higher frequency of adverse health symptoms. Three random-slope models were created via the linear mixed modeling method (LMM) to illustrate changes in reported health. RESULTS All three LMM models reported a reduction in participants' health score, particularly between T1 and T2, indicating a decrease in reported adverse health symptoms. CONCLUSION The intervention was successful in improving the health of carer-employees.
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Affiliation(s)
- Regina Ding
- School of Geography & Earth Sciences (Ms Ding, Dr Dardas, Dr Williams); Offord Center for Child Health Study (Dr Wang), McMaster University, Hamilton, Ontario, Canada
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Abstract
Role-based access control (RBAC) continues to gain popularity in the management of authorization concerning access to knowledge assets in organizations. As a socio-technical concept, the notion of role in RBAC has been overemphasized, while very little attention is given to the precursors: role strain, role ambiguity, and role conflict. These constructs provide more significant insights into RBAC design in Knowledge Management Systems (KMS). KMS is the technology-based knowledge management tool used to acquire, store, share, and apply knowledge for improved collaboration and knowledge-value creation. In this paper, we propose eight propositions that require future research concerning the RBAC system for knowledge security. In addition, we propose a model that integrates these precursors and RBAC to deepen the understanding of these constructs. Further, we examine these precursory constructs in a socio-technical fashion relative to RBAC in the organizational context and the status–role relationship effects. We carried out conceptual analysis and synthesis of the relevant literature, and present a model that involves the three essential precursors that play crucial roles in role mining and engineering in RBAC design. Using an illustrative case study of two companies where 63 IT professionals participated in the study, the study established that the precursors positively and significantly increase the intractability of the RBAC system design. Our framework draws attention to both the management of organizations and RBAC system developers about the need to consider and analyze the precursors thoroughly before initiating the processes of policy engineering, role mining, and role engineering. The propositions stated in this study are important considerations for future work.
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25
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Bell JF, Whitney RL, Young HM. Family Caregiving in Serious Illness in the United States: Recommendations to Support an Invisible Workforce. J Am Geriatr Soc 2020; 67:S451-S456. [PMID: 31074854 DOI: 10.1111/jgs.15820] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/20/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
Family caregivers provide the vast majority of care for individuals with serious illness living in the community but are not often viewed as full members of the healthcare team. Family caregivers are increasingly expected to acquire a sophisticated understanding of the care recipient's condition and new skills to execute complex medical or nursing tasks, often without adequate preparation and support, and with little choice in taking on the role. This review draws on peer-reviewed literature, government reports, and other publications to summarize the challenges faced by family caregivers of older adults in the context of serious illness and to identify opportunities to better integrate them into the healthcare workforce. We discuss promising approaches such as inclusion of family caregivers in consensus-based practice guidelines; the "no wrong door" function, directing consumers to needed resources, regardless of where initial contact is made; and caregiver-friendly workplace policies allowing flexible arrangements. We present specific recommendations focusing on research, clinical practice, and policy changes that promote family-centered care and improve outcomes for caregivers as well as persons with serious illness. J Am Geriatr Soc 67:S451-S456, 2019.
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Affiliation(s)
- Janice F Bell
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, Davis, California
| | - Robin L Whitney
- Hillblom Center on Aging, University of California, San Francisco, Fresno, California
| | - Heather M Young
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, Davis, California
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26
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Boumans NPG, Dorant E. The relationships of job and family demands and job and family resources with family caregivers' strain. Scand J Caring Sci 2020; 35:567-576. [PMID: 32400014 PMCID: PMC8247051 DOI: 10.1111/scs.12873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/18/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Background Because of an expected increase in the number of family caregivers, there is a growing public and scientific interest in family caregiving and more specifically in the combination of family care with paid employment. It is important to gain insight in the family caregivers’ strain and determining factors in the job and family domain. Aim The aim of the study was to examine the associations of job and family demands and job and family resources with indicators of caregivers’ psychological strain, that is caregiver burden, work‐related emotional exhaustion and general ill mental health. In our research, we focused on individuals who combine paid employment with family caregiving. Methods A cross‐sectional design was used. The study sample was derived in 2011 from a Dutch financial organisation and a healthcare organisation. A digital fully structured questionnaire was used. The sample consisted of 187 employees who identified themselves as family caregivers. Descriptive statistics and hierarchical linear regression analysis were performed. Results Job demands (i.e. workload, work–family conflict) and family demands (i.e. family care hours and family–work conflict) were significantly positively associated with all three domain‐specific indicators of strain. The resources of work–family and family–work enrichment and autonomy did not contribute to less experienced strain. More supervisor and colleague support was associated with lower ill mental health. Conclusion Our study showed that job demands (workload, work–family conflict) and family demands (family care hours, family–work conflict) were clearly associated with caregiver strain, while associations for job and family resources were not evident. It remains necessary to pay attention to the demanding aspects of dual roles of family caregivers but also to investigate the resources they have available at work as well as in their home situation and explore their potential reducing effect on family caregivers’ strain.
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Affiliation(s)
- Nicolle P G Boumans
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Elisabeth Dorant
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
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27
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Spann A, Vicente J, Allard C, Hawley M, Spreeuwenberg M, de Witte L. Challenges of combining work and unpaid care, and solutions: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:699-715. [PMID: 31845451 DOI: 10.1111/hsc.12912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
The number of people who combine work and unpaid care is increasing rapidly as more people need care, public and private care systems are progressively under pressure and more people are required to work for longer. Without adequate support, these working carers may experience detrimental effects on their well-being. To adequately support working carers, it is important to first understand the challenges they face. A scoping review was carried out, using Arksey and O'Malley's framework, to map the challenges of combining work and care and solutions described in the literature to address these challenges. The search included academic and grey literature between 2008 and 2018 and was conducted in April 2018, using electronic academic databases and reference list checks. Ninety-two publications were mapped, and the content analysed thematically. A conceptual framework was derived from the analysis which identified primary challenges (C1), directly resulting from combining work and care, primary solutions (S1) aiming to address these, secondary challenges (C2) resulting from solutions and secondary solutions (S2) aiming to address secondary challenges. Primary challenges were: (a) high and/or competing demands; (b) psychosocial/-emotional stressors; (c) distance; (d) carer's health; (e) returning to work; and (f) financial pressure. This framework serves to help those aiming to support working carers to better understand the challenges they face and those developing solutions for the challenges of combining work and care to consider potential consequences or barriers. Gaps in the literature have been identified and discussed.
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Affiliation(s)
- Alice Spann
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
| | - Joana Vicente
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Camille Allard
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Mark Hawley
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
| | - Marieke Spreeuwenberg
- Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Luc de Witte
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, Sheffield, UK
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Providing informal care next to paid work: explaining care-giving gratification, burden and stress among older workers. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWith an increasing retirement age, more older adults are combining employment with informal care-giving responsibilities. However, little is known about how older workers experience care-giving activities next to their paid jobs. This study aims to fill this gap by examining how the work situation (i.e. working hours, occupational status and perceived access to human resources practices) is associated with feelings of gratification, burden and stress in care-giving. Using data from the NIDI Pension Panel Survey, we study care-giving experiences – in other words, the extent to which care-giving activities are gratifying, burdensome or stressful – of 1,651 Dutch older workers (age 60–65) who provide care at least once per week. Multivariate analyses reveal that the work situation plays an explanatory role next to socio-demographic factors and indicators of the care-giving situation. Working care-givers who feel they have access to phased retirement and organisational health support experience care-giving as relatively less burdensome and stressful. Moreover, those with access to phased retirement experience relatively higher levels of gratification in care-giving. Our findings suggest that the availability of organisational support relates to lower levels of care-giving burden and stress, and to some extent to higher levels of gratification. Organisations thus play an important role in facilitating the combination of work and care-giving obligations in a context of longer working lives.
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Yu J, Yang Y, Kahana E. Productive Activity Patterns and Functional Health: A Comparison of Urban and Rural Chinese Older Adults. Int J Aging Hum Dev 2020; 91:538-562. [DOI: 10.1177/0091415019900168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the association between productive activity patterns and functional health trajectories of Chinese older adults and whether this association varies by urban/rural residence. Using three waves of the China Health and Retirement Longitudinal Study from a sample of 7,503 older adults, we first performed latent class analysis (LCA) to identify productive activity patterns based on four activities (work, caregiving, informal help, and formal volunteering). Next, multilevel regression analyses were conducted to assess the association between the identified productive activity patterns and functional health trajectories among older adults. Four productive activity patterns are identified from LCA: nonengagers, working-caregivers, workers, and helpers. We find that participation in productive activities is associated with slower functional health decline. The moderation effects of urban/rural differences are prominent across identified groups. Our findings highlight the importance of the urban/rural context in understanding productive aging and its health consequences among Chinese older adults.
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Affiliation(s)
- Jiao Yu
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Yulin Yang
- Department of Sociology, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, OH, USA
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Connors MH, Seeher K, Teixeira-Pinto A, Woodward M, Ames D, Brodaty H. Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study. Am J Geriatr Psychiatry 2019; 27:1206-1215. [PMID: 31230914 DOI: 10.1016/j.jagp.2019.05.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years. DESIGN Three-year observational study. SETTING Nine memory clinics in Australia. PARTICIPANTS One-hundred-and-eighty-five people with MCI and their caregivers. MEASUREMENTS Measures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period. RESULTS Between 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients' higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers' employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics. CONCLUSIONS High levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients - including severity of neuropsychiatric symptoms and functional impairment - and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.
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Affiliation(s)
- Michael H Connors
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Katrin Seeher
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | | | | | - David Ames
- University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, Australia; National Ageing Research Institute, Melbourne, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Sydney, Sydney, Australia.
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Huang J, Pacheco Barzallo D, Rubinelli S, Münzel N, Brach M, Gemperli A. What influences the use of professional home care for individuals with spinal cord injury? A cross-sectional study on family caregivers. Spinal Cord 2019; 57:924-932. [PMID: 31127196 PMCID: PMC6892416 DOI: 10.1038/s41393-019-0296-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE The objective of this study is to identify what characteristics of the family caregivers influenced the use of professional home care for persons with SCI in Switzerland. SETTING Community setting, nationwide in Switzerland. METHODS Questionnaires were filled out by the adult family caregivers of persons with SCI. Influence of characteristics of the caregivers was analyzed with regression models, adjusting for the characteristics of the person with SCI. Logistic regression was used for whether professional home care was used. Poisson regression was applied for the absolute and relative amount of professional home care. RESULTS In total, 717 family caregivers participated in the study (31% response rate). Among the participants, 33% hired professional home care for 10 h per week on average. The level of dependency of the persons with SCI had a significant influence on the utilization of care. The availability and proximity of the primary family caregiver, namely being spouse and cohabiting, reduced the amount of services used, whereas caregivers who worked full time employed more services. Higher levels of education and income increased the use of professional home care. Compared with their reference groups, caregivers with older age and those with a migratory background used comparable or larger absolute amount of professional services, which, however, represented a smaller proportion of total hours of care. CONCLUSIONS Adequate support requires consideration of the characteristics of both the caregiver and of the person with SCI. The needs of family caregivers should also be assessed systematically in the needs assessment.
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Affiliation(s)
- Jianan Huang
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Diana Pacheco Barzallo
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland.
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
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Dugan AG, Barnes-Farrell JL, Fortinsky RH, Cherniack MG. Acquired and Persistent Eldercare Demands: Impact on Worker Well-Being. J Appl Gerontol 2019; 39:357-367. [PMID: 31426697 DOI: 10.1177/0733464819870034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eldercare demands (ECD) may result in stress when finite resources needed to fulfill life roles (i.e., family, work) become scarce. ECD may be acquired, continue over time, or be relinquished. They thus may represent acute stress (immediate, severe) or chronic stress (persistent, milder). Workers at six U.S. manufacturing companies completed surveys (N = 520). ECD were operationalized as providing assistance to an adult aged 65+ years due to disability or illness. Workers were categorized into four ECD groups (persistent, relinquished, acquired, and none), and we examined the ECD groups' association with person-centric and work-centric outcomes. Respondents with acquired ECD had worse mental health and greater depressive symptoms than those with none, and those with persistent ECD had greater work stress and family-work conflict than those with none. Findings suggesting that acute stress is more related to person-centric outcomes and chronic stress is more related to work-centric outcomes could inform development of tailored interventions.
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Shen S, Chen Z, Xue M, Li F, Zhang R. How to relieve stress in adult child caregivers of the older adults with disabilities: a survey study from the city of Nanjing, China. SOCIAL WORK IN HEALTH CARE 2019; 58:291-303. [PMID: 30609905 DOI: 10.1080/00981389.2018.1563583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/09/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
The care of older adults with disabilities (OADs) in China is mostly provided by their adult offspring. As the population continues to age, carer stress will increase. A survey of 900 adult child caregivers of OADs was conducted in Nanjing City, Jiangsu Province, China, and used to investigate the status and stress levels of caregivers in order to explore effective support for offspring caregivers and suggest improvements to the social care system. Multiple linear regression models were used to examine the effects of coping strategies on carer stress. Caregivers experienced stress at moderate or high levels due to physical, psychological, financial, and work issues. Stress was significantly associated with OADs' health status and self-care ability, and the amount of care time. Caregivers sought help from their families to care for elderly parents, which significantly relieved stress. The purchase of social care services and professional medical services for OADs significantly reduced stress; however, for elderly persons with high self-care ability, the purchase of social care services increased caregiver stress, while government-subsidized family nursing allowances reduced it. It is necessary to focus on the role of family care to stimulate mutual family support, and to integrate society and government support systems.
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Affiliation(s)
- Suyan Shen
- a Department of Human Resources and Social Security , College of Public Administration, Nanjing Agricultural University , Nanjing , China
| | - Zhe Chen
- a Department of Human Resources and Social Security , College of Public Administration, Nanjing Agricultural University , Nanjing , China
| | - Mengying Xue
- a Department of Human Resources and Social Security , College of Public Administration, Nanjing Agricultural University , Nanjing , China
| | - Fang Li
- a Department of Human Resources and Social Security , College of Public Administration, Nanjing Agricultural University , Nanjing , China
| | - Ruixia Zhang
- a Department of Human Resources and Social Security , College of Public Administration, Nanjing Agricultural University , Nanjing , China
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Morimoto H, Furuta N, Kono M, Kabeya M. Stress-buffering Effect of Coping Strategies on Interrole Conflict among Family Caregivers of People with Dementia. Clin Gerontol 2019; 42:34-46. [PMID: 28990875 DOI: 10.1080/07317115.2017.1368764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine the stress-buffering effect of coping strategies on the adverse effects of interrole conflict on the mental health of employed family caregivers, and clarify the moderating role of attentional control on this stress-buffering effect. METHODS Data were drawn from a two-wave longitudinal online survey of employed Japanese family caregivers of people with dementia (263 males, 116 females; age 51.54 ± 9.07 years). We assessed interrole conflict, coping strategies, attentional control, mental health variables (psychological strain and quality of life), and confounding factors. RESULTS Hierarchical regression analyses controlled for sociodemographic factors found formal support seeking had a stress-buffering effect for strain- and behavior-based caregiving interfering with work (CIW) only on psychological strain, and was moderated by attentional control. Single slope analysis showed higher CIW was related to higher psychological strain in those with greater use of formal support seeking and lower attentional control, but not in those with higher attentional control. CONCLUSIONS Greater use of formal support seeking weakens the adverse effects of strain- and behavior-based CIW on psychological strain in people with high attentional control. CLINICAL IMPLICATIONS Attentional control is a key factor in the stress-buffering effect of formal support seeking on strain- and behavior-based CIW.
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Affiliation(s)
- Hiroshi Morimoto
- a Faculty of Psychology , Hiroshima International University , Hiroshima , Japan
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Sakka M, Goto J, Kita S, Sato I, Soejima T, Kamibeppu K. Associations among behavioral and psychological symptoms of dementia, care burden, and family-to-work conflict of employed family caregivers. Geriatr Gerontol Int 2018; 19:51-55. [PMID: 30556370 DOI: 10.1111/ggi.13556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/06/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
AIM The present study aimed to examine the associations among behavioral and psychological symptoms of dementia (BPSD) of persons with dementia (PWD), care burden and family-to-work conflict (FWC) of employed family caregivers. METHOD A cross-sectional study was carried out with employed adult daughter or son (or in-law) caregivers for PWD from two rural cities in Japan. FWC, care burden and the degree of BPSD were evaluated by the Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version and Dementia Behavior Disturbance Scale, respectively. Of the 200 questionnaires distributed, 130 were returned. A total of 53 respondents were not employed, and seven questionnaires had missing data for demographic variables, Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version or Dementia Behavior Disturbance Scale. Thus, complete data from 70 respondents were analyzed through structural equation modeling. RESULTS The mean age of employed family caregivers was 56 years, and 34 (48.5%) were men. The mean age of PWD was 84 years, and there were 68 (68.6%) men. The path model with a good fit was shown (root mean square error of approximation 0.136, comparative fit index 0.960 and goodness of fit index 0.965). The path model showed that BPSD affected FWC, and that the association was partially mediated by care burden. CONCLUSIONS The results show that a decrease in not only care burden, but also BPSD, of PWD is important for employed family caregivers to reduce their FWC and maintain their work-life balance. Geriatr Gerontol Int 2019; 19: 51-55.
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Affiliation(s)
- Mariko Sakka
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Home-Care & Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Goto
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takafumi Soejima
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Carr E, Murray ET, Zaninotto P, Cadar D, Head J, Stansfeld S, Stafford M. The Association Between Informal Caregiving and Exit From Employment Among Older Workers: Prospective Findings From the UK Household Longitudinal Study. J Gerontol B Psychol Sci Soc Sci 2018; 73:1253-1262. [PMID: 27927746 PMCID: PMC6146784 DOI: 10.1093/geronb/gbw156] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023] Open
Abstract
Objective This study investigated associations between informal caregiving and exit from paid employment among older workers in the United Kingdom. Method Information on caregiving and work status for 8,473 older workers (aged 50-75 years) was drawn from five waves of Understanding Society (2009-2014). We used discrete-time survival models to estimate the associations of caring intensity and type on the probability of exiting paid work (from >0 to 0 hours/week) in the following year. Models were stratified by sex and working hours, and adjusted for age, self-rated health, long-standing illness, occupation, and partner's employment status. Results No association was found between caregiving intensity and exit from paid work. Full-time employees who provided care within the household (women and men) or cared for a partner/spouse (women only) more likely to stop working, compared to those not providing care. Women who entered a caregiving role (more than 10 hours/week) were between 2.64 (95% confidence interval [CI]: 1.46, 4.79) and 4.46 (95% CI: 2.53, 7.88) times more likely to exit work (for part-time and full-time workers, respectively), compared to women providing no care. Discussion This study highlights the onset of caregiving as a key period for older workers. Ensuring that caregiving responsibilities are adequately recognized and supported may help extend working life.
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Affiliation(s)
- Ewan Carr
- Department of Epidemiology and Public Health, University College London, UK
| | - Emily T Murray
- Department of Epidemiology and Public Health, University College London, UK
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, UK
| | - Dorina Cadar
- Department of Epidemiology and Public Health, University College London, UK
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, UK
| | - Stephen Stansfeld
- Wolfson Institute of Preventative Medicine, Queen Mary University of London, UK
| | - Mai Stafford
- Department of Epidemiology and Public Health, University College London, UK
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Morimoto H, Furuta N, Kono M, Kabeya M. Can self-efficacy ameliorate interrole conflict among employed family caregivers? A moderated mediation approach. Aging Ment Health 2018; 22:999-1007. [PMID: 28569073 DOI: 10.1080/13607863.2017.1334192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study examined the moderation effect of different dimensions of self-efficacy on the way in which various types of interrole conflict mediate between caregiving demands and the mental health of employed family caregivers. METHOD Using a moderated mediation approach, we examined the moderation effect of self-efficacy on interrole conflict's mediation between caregiving demands and mental health (psychological strain and quality of life) in a sample of Japanese employed family caregivers who regularly provide care at home (263 males aged 53.14 ± 8.28 years and 116 females aged 47.92 ± 9.77 years). RESULTS Increased self-efficacy in managing dementia and in self-care were correlated with lower caregiving demands and better mental health among family caregivers. Self-efficacy in managing dementia was also positively correlated with increased interrole conflict. Increased caregiving demands were related to higher psychological strain in those with higher (+1SD), but not lower (-SD) self-efficacy in managing dementia. CONCLUSION Self-efficacy does not play a protective role in managing the effect of caregiving demands on interrole conflict. It also does not appear to protect against any indirect effects of caregiving demands on the mental health of employed family caregivers.
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Affiliation(s)
- Hiroshi Morimoto
- a Faculty of Psychology , Hiroshima International University , Higashi-Hiroshima , Japan
| | - Nobuo Furuta
- b Medical Center of Dementing Illness , Yokufukai Hospital , Suginami , Japan
| | - Mitsue Kono
- b Medical Center of Dementing Illness , Yokufukai Hospital , Suginami , Japan
| | - Mayumi Kabeya
- b Medical Center of Dementing Illness , Yokufukai Hospital , Suginami , Japan
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Kohl NM, Mossakowski KN, Sanidad II, Bird OT, Nitz LH. Does the Health of Adult Child Caregivers Vary by Employment Status in the United States? J Aging Health 2018; 31:1631-1651. [DOI: 10.1177/0898264318782561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study investigates whether the health effects of informal caregiving for aging parents vary by employment status in the United States. Two opposing hypotheses are tested: dual role strain and role enhancement. Method: Using national longitudinal data from the U.S. Health and Retirement Study, multivariate regression models predicted self-rated health and mental health among older adult children caregiving for their parents (2009-2012) and noncaregivers. Results: A statistically significant interaction was found between caregiving duration and employment, indicating that employed caregivers had significantly worse health than retired caregivers. Caregiving duration also predicted significantly higher levels of depressive symptoms. Discussion: Our results support the dual role strain hypothesis and suggest that caregiving for a parent up to 4 years is enough to predict significantly worse health among older adult Baby Boomers, especially those in the labor force. The broader implications for public health and workplace policies are discussed.
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Henning-Smith C, Lahr M. Rural-Urban Difference in Workplace Supports and Impacts for Employed Caregivers. J Rural Health 2018; 35:49-57. [DOI: 10.1111/jrh.12309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/10/2018] [Accepted: 05/14/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Carrie Henning-Smith
- Rural Health Research Center, Division of Health Policy and Management; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Megan Lahr
- Rural Health Research Center, Division of Health Policy and Management; University of Minnesota School of Public Health; Minneapolis Minnesota
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Ang S, Malhotra R. Expressive social support buffers the impact of care-related work interruptions on caregivers' depressive symptoms. Aging Ment Health 2018; 22:755-763. [PMID: 28426235 PMCID: PMC6105318 DOI: 10.1080/13607863.2017.1317329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess if expressive and instrumental social support from family and friends moderate the association of care-related work interruptions (e.g. leaving work for the older adult's doctor appointment) with depressive symptoms among working family caregivers of older adults. METHODS Data were from the Singapore Survey on Informal Caregiving (SSIC). A subsample of 662 dyads, each comprising an older care-recipient [home-dwelling Singaporean aged 75 and older receiving human assistance for at least one activity of daily living (ADL)] and his/her working family caregiver, was analysed. Caregiver depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale. Care-related work interruptions were scaled through the Mokken scaling procedure. Expressive social support was assessed using a scale by Pearlin and co-workers. Instrumental social support was based on the hours of ADL help provided to the care-recipient by any family member or friend, on behalf of the primary caregiver. A linear regression model, with interaction terms, assessed expressive and instrumental social support as moderators of the association of care-related work interruptions with caregiver depressive symptoms. RESULTS More care-related work interruptions were associated with more caregiver depressive symptoms. And, this association was moderated by expressive, but not instrumental, social support. CONCLUSION Our findings conform to previous qualitative work suggesting that caregivers' mental health may not benefit from instrumental support, but from receiving expressive support instead. Initiatives for improving the care experience of working caregivers of older adults should focus on promoting expressive support from their friends and family.
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Affiliation(s)
- Shannon Ang
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Sociology Programme, School of Social Sciences, Nanyang Technological University, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Savla J, Zarit SH, Almeida DM. Routine Support to Parents and Stressors in Everyday Domains: Associations With Negative Affect and Cortisol. J Gerontol B Psychol Sci Soc Sci 2018; 73:437-446. [PMID: 28379531 PMCID: PMC5927022 DOI: 10.1093/geronb/gbx033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/07/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives Adult children are involved a myriad of roles including providing routine (non-caregiving) support to a parent. Yet we know little about whether providing routine support to a parent is stressful and whether it has any associations with stressors in other life domains. Methods We use daily diary data (N = 127; Study Days = 424) from the National Study of Daily Experiences to determine whether providing routine support to an older parent is associated with higher negative affect and salivary cortisol. Results Results confirm that providing routine support and experiencing stressors at work were independently associated with negative affect and greater cortisol output. Stress reactions were not amplified, however, on days when adult children concurrently provided support to a parent and reported work stressors. Cutting back usual activities at work or home elevated negative affect but were not associated with an upsurge of cortisol production. Discussion Findings lend support to the caregiving career framework for understanding even casual routine assistance provided to a parent.
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Affiliation(s)
- Jyoti Savla
- Center for Gerontology, Virginia Tech, Blacksburg
| | - Steven H Zarit
- Human Development and Family Studies, Pennsylvania State University, University Park
| | - David M Almeida
- Human Development and Family Studies, Pennsylvania State University, University Park
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Ireson R, Sethi B, Williams A. Availability of caregiver-friendly workplace policies (CFWPs): an international scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e1-e14. [PMID: 27071368 PMCID: PMC5763327 DOI: 10.1111/hsc.12347] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2016] [Indexed: 05/13/2023]
Abstract
Little research has been done to summarise: what is currently available to caregiver-employees (CEs), what types of employers are offering caregiver-friendly workplace policies (CFWPs), and the characteristics of employers offering CFWPs. The purpose of this scoping review was to explore the availability of CFWPs within workplaces on an international scale while being observant of how gender is implicated in care-giving. This paper followed the Arksey & O'Malley (2005) methodology for conducting scoping reviews. The authors applied an iterative method of determining study search strings, study inclusion and data extraction, and qualitative thematic analysis of the search results. Searches were performed in both the academic and grey literature, published between 1994 and 2014. A total of 701 articles were found. Seventy (n = 70) articles met all inclusion criteria and were included in this review. Four main qualitative themes were identified: (i) Diversity and Inclusiveness, (ii) Motivation, (iii) Accessibility, and (iv) Workplace Culture. Policy recommendations are discussed. This scoping review narrows the gap in the literature with respect to determining: (i) the workplaces which offer CFWPs, (ii) the sectors of the labour force shown to be supportive and (iii) the most frequently offered CFWPs.
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Affiliation(s)
- Rachelle Ireson
- School of Geography and Earth SciencesMcMaster UniversityHamiltonONCanada
| | - Bharati Sethi
- School of Geography and Earth SciencesMcMaster UniversityHamiltonONCanada
| | - Allison Williams
- School of Geography and Earth SciencesMcMaster UniversityHamiltonONCanada
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Oldenkamp M, Bültmann U, Wittek RPM, Stolk RP, Hagedoorn M, Smidt N. Combining informal care and paid work: The use of work arrangements by working adult-child caregivers in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e122-e131. [PMID: 28762603 DOI: 10.1111/hsc.12485] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 06/07/2023]
Abstract
An increasing number of people combine paid work with the provision of informal care for a loved one. This combination of work and care may cause difficulties, necessitating adaptations at work, i.e. work arrangements. The present study explores what types of work arrangements are used by working caregivers, and which caregiver, care and work characteristics are associated with the use of these work arrangements. Within the Lifelines Informal Care Add-on Study (Lifelines ICAS), data on 965 Dutch informal caregivers in the North of the Netherlands were collected between May 2013 and July 2014 (response rate 48%), and data on 333 working adult-child caregivers (aged 26-68 years, 82% female) were used in this study. A small majority (56%) of the working caregivers used one or more work arrangement(s): taking time off (41%), individual agreements with supervisor (30%), formal care leave arrangement (13%), and reduction in paid work hours (6%). Logistic regression analyses showed that long working hours (OR 1.06, 95% CI 1.01-1.08), and the experience of more health problems (OR 2.54, 95% CI 1.56-4.05) or a disrupted schedule due to caregiving (OR 2.50, 95% CI 1.66-3.78) increased the chance to have used one or more work arrangements. Lower educated working caregivers were less likely to have used a formal care leave arrangement (tertiary vs. primary education OR 2.75, 95% CI 1.13-6.67; tertiary vs. secondary education OR 1.27, 95% CI 1.27-5.09). Policy makers should inform working caregivers about the availability of the different work arrangements, with specific attention for low educated working caregivers. Employers need to consider a more caregiver-friendly policy, as almost half of the working adult-child caregivers did not use any work arrangement.
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Affiliation(s)
- Marloes Oldenkamp
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rafael P M Wittek
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Sciences, Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Geriatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Liu H, Lou VWQ. Patterns of productive activity engagement as a longitudinal predictor of depressive symptoms among older adults in urban China. Aging Ment Health 2017; 21:1147-1154. [PMID: 27392120 DOI: 10.1080/13607863.2016.1204983] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Using two waves of panel data from the China Health and Retirement Longitudinal Study, this study prospectively assessed whether four distinct patterns of productive activity engagement would predict depressive symptoms among older adults in urban China two years later. METHODS A sample of urban residents aged 60 or above at Wave 1 and who were interviewed in both waves (N = 2398) was used. Latent class analysis (LCA) was conducted to identify distinct patterns of productive activity engagement that occurred within the Wave 1 data. Next, the generalized estimating equations were used to assess whether identified patterns predicted the levels of depressive symptoms measured at Wave 2. RESULTS Our use of LCA confirmed the existence of four distinct patterns of productive activity engagement among the study sample: Informal Helper/Carer, Working-Caring Engager, Civic Contributor, and Low/Spousal Carer. All of these three patterns exhibited significantly lower levels of depressive symptoms than that of Low/Spousal Carer two years later. CONCLUSIONS Our use of individual-based categorization of productive engagement better captured the reality of older adults performing various productive activities than summative scales of productive activities did and, therefore, provided a more valid clarification of differential well-being outcomes among older adults.
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Affiliation(s)
- Huiying Liu
- a Department of Social Work and Social Administration , The University of Hong Kong , Hong Kong , China
| | - Vivian W Q Lou
- a Department of Social Work and Social Administration , The University of Hong Kong , Hong Kong , China.,b Sau Po Center on Ageing , The University of Hong Kong , Hong Kong , China
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DePasquale N, Polenick CA, Davis KD, Moen P, Hammer LB, Almeida DM. The Psychosocial Implications of Managing Work and Family Caregiving Roles: Gender Differences Among Information Technology Professionals. JOURNAL OF FAMILY ISSUES 2017; 38:1495-1519. [PMID: 28694554 PMCID: PMC5501489 DOI: 10.1177/0192513x15584680] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An increasing number of adults, both men and women, are simultaneously managing work and family caregiving roles. Guided by the stress process model, we investigate whether 823 employees occupying diverse family caregiving roles (child caregiving only, elder caregiving only, and both child caregiving and elder caregiving, or "sandwiched" caregiving) and their noncaregiving counterparts in the information technology division of a white-collar organization differ on several indicators of psychosocial stress along with gender differences in stress exposure. Compared with noncaregivers, child caregivers reported more perceived stress and partner strain whereas elder caregivers reported greater perceived stress and psychological distress. With the exception of work-to-family conflict, sandwiched caregivers reported poorer overall psychosocial functioning. Additionally, sandwiched women reported more family-to-work conflict and less partner support than their male counterparts. Further research on the implications of combining a white-collar employment role with different family caregiving roles is warranted.
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Affiliation(s)
| | | | - Kelly D. Davis
- The Pennsylvania State University, University Park, PA, USA
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Pei X, Luo H, Lin Z, Keating N, Fast J. The Impact of Eldercare on Adult Children’s Health and Employment in Transitional China. J Cross Cult Gerontol 2017; 32:357-372. [DOI: 10.1007/s10823-017-9330-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Measurement of inter-role conflict among employed family caregivers of elderly people with dementia. ACTA ACUST UNITED AC 2017. [DOI: 10.4992/jjpsy.88.16205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Liu H, Lou WQ. Patterns of productive activity engagement among older adults in urban China. Eur J Ageing 2016; 13:361-372. [PMID: 28804388 PMCID: PMC5550611 DOI: 10.1007/s10433-016-0387-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study aims to identify patterns of productive activity engagement among older adults in urban China. Once patterns are identified, we further explore how a set of individual characteristics is associated with these patterns. Using data from the 2011 baseline survey of the China Health and Retirement Longitudinal Study (CHARLS), we performed a latent class analysis (LCA) on a national representative sample of adults aged 60 years and over (N = 3019). A specified range of productive activity indicators that fit the context of urban China was used for performing LCA (including working, grandchildren's care, parental care, spousal care, informal helping, and formal volunteering). A multinomial logistic regression was used to assess whether individual characteristics are associated with the identified patterns. The results indicated that a four-class model fit the data well, with the interpretable set of classes: spouse carer (51.2 %), working grandparents (21.7 %), multifaceted contributor (16.6 %), and light-engaged volunteer (10.5 %). Age, gender, education, number of children, proximity with the nearest child, household composition and functional status contributed to differentiating these classes. This study captured the reality of productive engagement among older adults by drawing attention to how multiple productive activities intersect in later-life stages. Our findings have implications for policy-makers, health care practitioners, and community advocates to develop programs that facilitate this aging population in assuming meaningful productive activities.
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Affiliation(s)
- Huiying Liu
- University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wei Qun Lou
- University of Hong Kong, Pok Fu Lam, Hong Kong
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DePasquale N, Davis KD, Zarit SH, Moen P, Hammer LB, Almeida DM. Combining Formal and Informal Caregiving Roles: The Psychosocial Implications of Double- and Triple-Duty Care. J Gerontol B Psychol Sci Soc Sci 2016; 71:201-11. [PMID: 25271309 PMCID: PMC4757948 DOI: 10.1093/geronb/gbu139] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/25/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Women who combine formal and informal caregiving roles represent a unique, understudied population. In the literature, healthcare employees who simultaneously provide unpaid elder care at home have been referred to as double-duty caregivers. The present study broadens this perspective by examining the psychosocial implications of double-duty child care (child care only), double-duty elder care (elder care only), and triple-duty care (both child care and elder care or "sandwiched" care). METHOD Drawing from the Work, Family, and Health Study, we focus on a large sample of women working in nursing homes in the United States (n = 1,399). We use multiple regression analysis and analysis of covariance tests to examine a range of psychosocial implications associated with double- and triple-duty care. RESULTS Compared with nonfamily caregivers, double-duty child caregivers indicated greater family-to-work conflict and poorer partner relationship quality. Double-duty elder caregivers reported more family-to-work conflict, perceived stress, and psychological distress, whereas triple-duty caregivers indicated poorer psychosocial functioning overall. DISCUSSION Relative to their counterparts without family caregiving roles, women with combined caregiving roles reported poorer psychosocial well-being. Additional research on women with combined caregiving roles, especially triple-duty caregivers, should be a priority amidst an aging population, older workforce, and growing number of working caregivers.
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Affiliation(s)
- Nicole DePasquale
- Department of Human Development & Family Studies, The Pennsylvania State University, University Park.
| | - Kelly D Davis
- Department of Human Development & Family Studies, The Pennsylvania State University, University Park
| | - Steven H Zarit
- Department of Human Development & Family Studies, The Pennsylvania State University, University Park
| | - Phyllis Moen
- Department of Sociology, University of Minnesota, Minneapolis
| | | | - David M Almeida
- Department of Human Development & Family Studies, The Pennsylvania State University, University Park
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J. Beutell N, A. Schneer J. Work-family conflict and synergy among Hispanics. JOURNAL OF MANAGERIAL PSYCHOLOGY 2014. [DOI: 10.1108/jmp-11-2012-0342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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