Sources of stress for family caregivers of institutionalized dementia patients

Pilot Study of the Residential Care Transition Module to Support Australian Spouses of People with Dementia

OBJECTIVES

Spouses are at risk of poor psychosocial outcomes following placement of their partner with dementia into long-term care. The Residential Care Transition Module (RCTM) is a psychosocial intervention developed in the United States to support carers post-placement. This study aimed to test the RCTM delivered by telephone to Australian spousal carers.

METHODS

A small-scale RCT [N = 21] was conducted to test feasibility of recruitment, retention, acceptability, and preliminary effects on measures of stress, grief, depression, guilt, quality-of-life, and satisfaction with care, compared to a group receiving printed information.

RESULTS

The Transition Counselor and study participants considered the intervention delivery, dose, and content as acceptable. Retention was high (91%). At follow-up, significant time effects were found for stress, depression and "nursing home hassles." A significant interaction effect was found for quality-of-life in favor of the comparison group. No effects were found for guilt or overall grief, however a promising result regarding the sub-scale of "acceptance of loss" was found in favor of the RCTM.

CONCLUSIONS

The delivery of the RCTM to Australian spousal carers was feasible and acceptable.

CLINICAL IMPLICATIONS

The RCTM shows potential for improving support to spouses of people with dementia following long-term care placement.

The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

BACKGROUND

Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia.

METHODS

In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes.

RESULTS

We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances.

CONCLUSION

Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.

The impact of Covid-19-related distancing on the well-being of nursing home residents and their family members: a qualitative study

OBJECTIVES

The aim of this study is to examine the consequences of Covid-19-related isolation and social restrictions on the well-being of nursing home residents and their family members, and to analyze how distancing has affected the relationships of family members with residents and the nursing home staff.

DESIGN

The data consist of 41 thematic one-on-one interviews conducted during May-December 2020 with family members of nursing home residents. Convenience sampling was utilized by asking several nursing homes in different parts of Finland to relay a contact request from the researchers to the residents' family members. The main themes of the interviews were lockdown and visiting restrictions. Subthemes included the frequency of visits, other means of interaction, changes in the relationships of family members with their loved ones and with nursing home staff, and the feelings aroused by the situation. The interviews were audio recorded and transcribed verbatim, resulting in 794 pages of data.

METHOD

The qualitative study uses inductive content analysis. NVivo12 software facilitated the systematic coding of the data.

RESULTS

According to the family members, distancing aggravated the residents' pre-existing conditions: they reported a sudden progression in memory disorders and significant deterioration in physical abilities, for example. Both residents and family members experienced anxiety, grief, and severe stress, and family members expressed concern that residents might die due to a lack of social contact and activity. Family members were also frustrated about not being able to touch their relatives or participate in their care, and therefore sometimes thought that their visits were useless. New forms of interaction with family members, introduced by the nursing homes, were appreciated. However, some family members perceived the interactional protocols as unfair and complained about insufficient information.

CONCLUSIONS

The findings underline the need for nursing homes to implement a good interactional protocol. Overall, the results show that the measures taken to protect residents' health during the Covid-19 outbreak were short-sighted in terms of the social dimension of well-being. It is therefore important to continue developing safe and humane solutions for interaction when social restrictions are in place. Tweetable abstract: Covid-19-related distancing has caused anxiety, grief, and severe stress for nursing home residents and their family members.

Getting Along in Assisted Living: Quality of Relationships Between Family Members and Staff

BACKGROUND AND OBJECTIVES

Assisted living facilities (ALFs) have quickly expanded as an alternative to nursing homes. Research on nursing homes has revealed problems in relationships between family members and staff. However, little is known about these relationships within ALFs. The purpose of the current study was to examine the prevalence of conflict and positive and negative interactions from the perspective of both family members and staff and to examine the effects of positive and negative aspects of the relationship on salient staff and family outcomes in ALFs.

RESEARCH DESIGN AND METHODS

Data were collected from 252 family members and 472 staff members across 20 ALFs who participated in the Partners in Care in Assisted Living study. Participants completed measures including interpersonal conflict, depressive symptoms, perception of treatment, and stress related to caregiving.

RESULTS

Conflict among family and staff members was found to be relatively low. For staff, interpersonal conflict and treatment by family members significantly predicted burnout and depressive symptoms. For families, only female gender significantly predicted burden. Subgroup analyses, however, indicated that the effect of interpersonal conflict was significantly associated with perceived caregiver burden among family members whose relative had dementia.

DISCUSSION AND IMPLICATIONS

Despite the relatively harmonious relationships among family-staff in ALFs, sources of conflict and negative interactions were identified, revealing the importance of collaborative relationships and the influence these relationships have on both family and staff outcomes. These findings can inform intervention efforts to improve family-staff interactions within ALFs.

Exploring Strain in Community and Nursing Home Family Caregivers

This research compared strain among 581 family caregivers of nursing home and community dwelling older persons whose level of cognitive impairment ranged from none to severe. The study explored differences between the two caregiver groups in global and domain-specific strain, the impact of elders' cognitive impairments on strain, and correlates of strain. In models controlling for important correlates of caregiving, findings revealed no differences between caregiver groups on any measure of strain. Cognitive impairment was associated with increases in all strain measures for community caregivers, but only increased overall and emotional strain for nursing home caregivers. Characteristics of caregivers and caregiving situations were related to strain differently, depending on the domain of strain and examined and the site of care. Implications for practice in nursing home settings are discussed.

Development and psychometric properties of the family distress in advanced dementia scale

OBJECTIVE

The majority of scales to measure family member distress in dementia are designed for community settings and do not capture the unique burdens of the nursing home (NH) environment. We report the psychometric properties of a new Family Distress in Advanced Dementia Scale for use in the NH setting.

DESIGN, SETTING, PARTICIPANTS

Cross-sectional questionnaire of 130 family member health care proxies of NH residents with advanced dementia in 31 Boston-area NHs.

METHODS

Thirty-one initial items were evaluated, measuring the frequency over the past 3 months of sources of distress. Exploratory factor analysis identified domains of distress; Cronbach's alpha was computed for each domain. Associations between the domains and other measures were evaluated using Pearson correlation coefficients, including measures of depression (PHQ-9), satisfaction with care (Satisfaction with Care at the End-of-Life in Dementia [SWC-EOLD]), and caregiver burden (Zarit Burden Interview short version).

RESULTS

Factor analysis suggested 3 domains: emotional distress (9 items), dementia preparedness (5 items), and NH relations (7 items). Cronbach's alpha coefficients were 0.82, 0.75, and 0.83 respectively. The PHQ-9 correlated most strongly with the emotional distress factor (r = 0.34), the SWC-EOWD correlated most strongly with the NH relations factor (r = 0.35), as did the Zarit Burden Scale (r = 0.50).

CONCLUSIONS

The Family Distress in Advanced Dementia Scale encompasses 3 domains of distress. This scale represents a much needed tool to assess distress among family members of NH residents with advanced dementia and provides a metric to evaluate interventions in the population.

Experiences of spouses of people with dementia in long-term care

The experiences of 10 spouses of people with dementia in long-term care were explored using semi-structured interviews. The data were analysed using interpretative phenomenological analysis (IPA) which resulted in four themes: ‘Identity: till death us do part’; ‘Making sense of change’; ‘Relationship with care provided: visiting as surveillance’; and ‘Relationship with the future: hope versus despair’. The findings highlighted the presence of conflicting feelings for the spouses, with positive feelings being voiced against a context of despair. Their perceptions of the care provided and the spousal relationship also highlighted the value of their views in supporting this group of people, improving dementia care and, hence, the importance of their involvement in implementing a ‘relationship-centred’ care approach.

A telephone-delivered psychosocial intervention improves dementia caregiver adjustment following nursing home placement

OBJECTIVE

Study the preliminary efficacy of a telephone intervention, Family Intervention: Telephone Tracking-Nursing Home (FITT-NH) for improving dementia caregivers' adjustment following nursing home placement.

METHODS

Caregivers were enrolled on average 6 weeks following the care-recipients' placement in a nursing home. Baseline assessment included self-report measures of caregiver emotional functioning, staff-caregiver interactions, placement satisfaction, health-related quality of life, and social support. Caregivers were randomly assigned to FITT-NH (n = 24) or a non-contact control condition (n = 22). Caregivers were urn randomized to balance groups on caregiver gender, relationship (spouse versus other), and facility type (dementia special care versus general). The intervention was entirely telephone-delivered in 10 contacts over 3 months. Caregivers randomized to non-contact control were not prevented from using other community-based mental health or support resources, therefore reflecting standard care. Intervention strategies were based on assessment of caregiver emotional adjustment, family functioning, staff-caregiver interactions, health, and social support. Treatment strategies are based on models of stress and coping process and family functioning.

RESULTS

Groups did not differ in caregiver age, education, gender, relationship to the care recipient, length of caregiving, length of dementia diagnosis, or time since placement. Using mixed model analysis of variance, caregivers receiving FITT-NH showed a significant reduction in feelings of guilt related to placement, F(1,43) = 5.00, p < 0.05, and reported more positive perceptions of interactions with staff, F(1,43) = 4.59, p < 0.05, compared to standard care.

CONCLUSION

Findings provide preliminary evidence for FITT-NH as a potentially efficacious, brief, targeted psychosocial intervention for improving caregiver emotional adjustment following nursing home placement.

Psychometric properties of the Caregiving Burden Scale for Family Caregivers with Relatives in Nursing Homes: scale development

AIM

Most family caregivers continue their caregiving for frail relatives after admitting them to long-term care facilities. The characteristics of this caregiving differ from those related to caregiving in home-care settings. Thus, a new tool to evaluate the burden of family caregivers in institutional settings is needed. The aim of this study was to develop a new scale, the Caregiving Burden Scale for Family Caregivers with Relatives in Nursing Homes, and to confirm its validity and reliability.

METHODS

We conducted two cross-sectional questionnaire surveys. The participants were a convenience sample of family members of residents in seven nursing homes for the validation study and in three nursing homes for the test-retest study in Japan. Statistical analyses examined exploratory/confirmatory factor analyses, internal consistency, concurrent/discriminate validity, and test-retest reliability.

RESULTS

A four-factor solution with 16 items was selected as the most interpretable questionnaire. In the confirmatory factor analysis, the indices of fitness highly supported these results. The Cronbach's alpha coefficient for the total score was 0.86 and varied between 0.77 and 0.87 in the four domains. The scale showed moderate correlation with the Nursing Home Hassles Scale, suggesting its concurrent validity. The four domains had only a medium correlation with each other, indicating discriminate validity.

CONCLUSIONS

The developed scale has acceptable validity and reliability for measuring the caregiving burden of family members with relatives in Japanese nursing homes. Future studies using the scale might lead to the improvement of care for family members with relatives in a long-term care setting.

Group living homes for older people with dementia: the effects on psychological distress of informal caregivers

OBJECTIVES

The aim of this study was to investigate the effects of group living care for people with dementia on the psychological distress of informal caregivers, compared with regular nursing home care.

METHOD

This study had a quasi-experimental design with two measurements. 67 primary informal caregivers in 19 group living homes and 99 primary informal caregivers in seven regular nursing homes filled in a questionnaire upon admission (baseline measurement) of their relative and six months later (effect measurement). Linear and logistic regression analyses were performed on three outcomes of psychological distress - psychopathology, caregiving competence and caregiver burden.

RESULTS

There were no significant differences in caregiver competence and caregiver burden between informal caregivers of residents in group living homes and those in regular nursing homes, although there was a trend towards less psychopathology in group living homes after adjustment for confounding.

CONCLUSION

Informal caregivers of residents in group living homes do not have less psychological distress than informal caregivers of residents in regular nursing homes. Although there was a trend towards less psychopathology in informal caregivers of group living homes, the amount of symptoms remained very high in both caregiver groups. This means that the psychological well-being of caregivers deserves the continuing attention of health care providers, also after admittance of their relative in a nursing home facility.

Quality of life for caregivers of people with Alzheimer's disease

AIM

This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer's disease and to identify factors that affect their quality of life.

BACKGROUND

The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers' quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer's disease.

METHOD

A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer's disease. Data were collected using interviews between November 2004 and June 2005.

FINDINGS

Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient's illness and stress.

CONCLUSION

Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems.

Partners in caregiving in a special care environment: cooperative communication between staff and families on dementia units

PURPOSE

This article reports the results of a randomized, controlled evaluation of Partners in Caregiving in a Special Care Environment, an intervention designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs.

DESIGN AND METHODS

Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents' family members, followed by a joint meeting with facility administrators.

RESULTS

Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs.

IMPLICATIONS

Effective staff and family partnerships are critical in caring for residents with dementia. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.

The Importance of Family Relationships With Nursing Facility Staff for Family Caregiver Burden and Depression

We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience.

Impact of problem alcohol use on patient behavior and caregiver burden in a geriatric assessment clinic

There has been a growing interest in understanding issues surrounding alcohol use in late life. Information about the relationship of alcohol use to behavioral problems in older persons living in the community is particularly limited. This study used information obtained from an outpatient geriatric assessment clinic to study this relationship and the effects of these behaviors on caregivers. Data on alcohol use, problem behaviors, and caregiver burden were collected prospectively in consecutive patients undergoing geriatric assessment primarily for cognitive problems over a 3-year period. All patients were evaluated by a multidisciplinary team, which included a geriatric psychiatrist. The evaluation screened for current and/or past alcohol use through interviews with the patient and a collateral source. The collateral source also completed the Neuropsychiatric Inventory and the Family Burden Scale. Subjects were classified into 2 groups: those with a current or past alcohol problem and those with no alcohol problem. A total of 349 patients were evaluated, with 17.8% being designated as having a current or past alcohol problem. This subgroup represented 35% of the men and 9% of the women from the study population. Approximately half of the subgroup was actively drinking alcohol. Patients with a history of problem alcohol use, regardless of current use and cognitive status, exhibited more behavioral disturbances including agitation, irritability, and disinhibition. Their caregivers reported significantly higher caregiver distress. Current or past alcohol problem use was frequent in this population of frail, older adults undergoing geriatric assessment. Regardless of current alcohol use, these patients displayed more behavioral disturbances than those without a history of problem drinking, and their caregivers experienced significantly more burden. A history of problem drinking appears to be a significant marker for behavioral disturbances in late life and merits further study.

Correlates of physical health of informal caregivers: a meta-analysis

Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.

Persistent Family Concerns in Long-term Care Settings: Meaning and Management

PURPOSE

The aim of this study was to understand institutional and family caregiver characteristics that contribute to the failure to resolve families' persistent complaints about nursing home care of their relatives.

DESIGN AND METHODS

Key informant interviews with 9 family members who had persistent concerns about the care of their relatives were conducted. Two focus groups with 5 nurse managers provided staff perceptions of families whose persistent concerns remained unresolved. Content analysis of both individual interviews and focus groups resulted in the extraction of salient themes.

RESULTS

Factors associated with persistent discord between families and staff included caregivers' perceptions of staff as incompetent, interfamilial conflicts, and unresolved psychosocial issues. Institutional factors contributing to persistent negative perceptions of care included staff's vulnerability in the face of challenges to their professional competence and stress due to disproportionate amounts of time spent educating and supporting health care aids to cope with distraught families.

IMPLICATIONS

The failure to settle, in a mutually satisfactory manner, the complaints of this subgroup of families is discussed in the context of unresolved family issues that interact with institutional failure to respond in a manner that conveys understanding of caregiver stress that is invariably exacerbated when a family member is placed in a long-term care facility.

Family and Staff Partnerships in Long-Term Care: A Review of the Literature

Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy, which espouses holistic care. The quality and enjoyment of the experience, however, is frequently fraught with problems and challenges for both the family and the staff involved. In residential aged care, partnerships are a complex mix of interactions among the older adult resident, the family, and the caregiving staff. To understand how family involvement in this environment can be made more meaningful, nurses need to be cognizant of how family members experience the caregiving role and how they are perceived by nursing home staff and residents. The relevant literature of the past 20 years is reviewed and key issues central to an understanding of "family care" in the nursing home from the perspective of the family, the nursing home resident, and the nursing home staff are highlighted in this article.

Defining the role of the caregiver in Alzheimer's disease treatment

The day-to-day responsibility of caring for a person with dementia often exacts a toll upon the caregiver, which may be manifested psychologically, physically, socially and financially. The last decade has witnessed the advent of drug availability for the treatment of Alzheimer's disease, specifically the cholinesterase inhibitors. Caregivers are integral to the initiation, administration and monitoring of treatment. In particular, they provide substitute informed consent when patients are no longer competent to do so. While there is evidence that cholinesterase inhibitors may reduce caregiver burden and time spent assisting patients, there are also burdens associated with being the person responsible for administering medication. Caregivers are key to research into the use of medications for Alzheimer's disease. They have roles in recruitment and consent and monitoring response and adverse effects. Increasingly, caregivers themselves are recognised as legitimate targets for evaluating the efficacy of new pharmacological agents for Alzheimer's disease (as benefits have been demonstrated for them). Caregivers have responsibilities regarding the drug treatment of patients with Alzheimer's disease, and require information about the medications so that they can have realistic expectations. Doctors need to work in partnership with caregivers and patients when prescribing drugs for Alzheimer's disease.

A cooperative communication intervention for nursing home staff and family members of residents

PURPOSE

This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff.

DESIGN AND METHODS

Participants included 932 relatives and 655 staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Parallel training sessions on communication and conflict resolution techniques were conducted with the family and staff in the treatment group, followed by a joint meeting with facility administrators.

RESULTS

Positive outcomes were found for both family and staff members in the treatment group. Both groups showed improved attitudes toward each other, families of residents with dementia reported less conflict with staff, and staff reported a lower likelihood of quitting.

IMPLICATIONS

Multiple studies report significant interpersonal stress between family members of nursing home residents and facility staff members. Partners in Caregiving appears to be an effective way to improve family-staff relationships in nursing homes.

Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.

Burden among family caregivers of persons with Alzheimer's disease in nursing homes

PURPOSE

This article examines family caregiver burden after placement of a relative with Alzheimer's disease or a related dementia in a nursing home.

DESIGN AND METHODS

A systems-oriented contextual approach was used to study burden in 276 family caregivers.

RESULTS

SAS PROC MIXED analysis showed burden to be associated with caregiver age, length of time involved in caregiving, custodial units, involvement in hands-on care, and expectations for care.

IMPLICATIONS

The findings suggest that more services aimed at relieving caregiver burden after nursing home placement may be warranted, particularly so for caregivers who are older and for those who had a shorter length of involvement in direct caregiving before institutionalization.

The changes in caregiver burden following nursing home placement

This longitudinal study explored changes in perceived burden among Taiwanese family caregivers (n=77) from nursing home placement of an elder to four months postadmission. Higher burden at placement was related to the level of dependence of the care recipients (p=0.004), or caregiver's poor health (p<0.01). After nursing home placement for four months, global burden decreased (p<0.01) contributed primarily by lessened burden in three sub-scales: lack of family support, impact of schedule and impact of health. Burden scores on caregiver esteem and impact of finances were not decreased after placement. Duration of caregiving was the only demographic factor predicting change in global burden (p<0.001). Changes in impact on finances, and impact on health were, respectively, predicted by the perceived health (p=0.005), and religious preference (p=0.01). These results provide valuable information to healthcare providers for an understanding of the changes of caregiving burden after nursing home placement and the correlates of these changes, which may help devise an appropriate policy for alleviating the caregiver's burden.

The quality of nursing home care: do the opinions of family members change after implementation of emotion-oriented care?

OBJECTIVE

The present study focuses on opinions on the quality of nursing home care of family members of nursing home residents with dementia. Furthermore, we examined whether family members' appreciation of the care increased as a result of the implementation of emotion-oriented care.

DESIGN

Randomized clinical trial.

INSTRUMENT

An 18-item questionnaire was developed. The following subjects were addressed: communication activities between staff and family members; satisfaction regarding contacts with staff; the extent to which family members can participate in care; the contact that family members experience with the person with dementia, and opinions about the way in which nursing staff treat residents.

RESULTS

Most family members already had a positive opinion on the nursing home care prior to the implementation of emotion-oriented care. The most positive assessment concerned the way in which nursing staff treated residents. The lowest scores concerned communication activities between ward staff and family members. Comparison of the first and end measurements showed that in general opinions on the quality of care did not change.

STUDY LIMITATIONS

A large number of incomplete questionnaires made it impossible to conduct factor analysis on the classification of the questions in various sections and therefore allowed us only to make statements at the item level.

CONCLUSIONS

For the most part family members had a positive opinion on the nursing home care. In general, implementation of emotion-oriented care did not lead to a more positive assessment. Despite the generally accepted notion that involving family members in care is important, family members were regularly treated as outsiders. This demonstrates that there is room for improvement in the communication by nursing home staff with family members (e.g. more frequent contacts and information about the illness).

Long-term care for older adults. The role of the family

Family members are involved in all aspects of a frail or ill older adult's care before, during, and after admission into a long-term care facility. However, their role within the facility is not always clearly defined. This article addresses issues regarding facility policies and staff attitudes toward family involvement, particularly whether the family member is seen as an integral part of the care system or peripheral to the care system. An emphasis is placed on the use of open communication to prevent misunderstandings and disagreements between staff and family and to promote good quality care and acceptable quality of life for the resident.

The interplay of institution and family caregiving: relations between patient hassles, nursing home hassles and caregivers' burnout

This population-based study investigated the relationship between stresses (hassles) and burnout for 30 family caregivers and their institutionalized demented elderly. The Burnout Measure, the Patient Hassles Scales and the Nursing Home Hassles Scale were used. Hassles included: patient hassles (cognitive, behavior, basic ADL) and nursing home hassles (caregiver - staff, patient - staff, practical/logistical). The caregiver's characteristics are described in relation to burnout and the caregiver's most frequent hassles are discussed. All subscales except basic ADL were correlated to burnout. However, regression analysis showed the nursing home hassles to be the most important stresses explaining variance in burnout among family caregivers.

Is there a difference between family caregiving of institutionalized elders with or without dementia?

Based on the stress and coping model of Lazarus and Folkman, the aim of this comparative study was to determine whether the caregiving experience of the caregivers of an institutionalized demented relative is different from the one of the caregivers whose relative does not suffer from dementia. Five dimensions of the caregiving experience were considered: stressors, cognitive appraisal of the stressors, social support, coping strategies and well-being. The sample consisted of primary caregivers of a demented and a nondemented relative. Results revealed that the caregivers of a demented relative were exposed to more stressors than the caregivers of a nondemented relative. Functional impairment as well as depressive behaviors were appraised as more disturbing. According to MANCOVA analysis, formal and informal social support seems to play a protective role in the psychological distress of the caregivers of a demented relative. There was no difference between the two groups with regard to their coping strategies. Overall, the caregivers of a demented relative seemed to experience some dimensions of caregiving in a different way compared with their counterparts, and the nature of dementia in itself helps to explain this difference.

An evaluation of a family visit education program

OBJECTIVES

This study was designed to examine the impact of the Family Visit Education Program (FVEP) on family members, nursing staff, and nursing home residents with dementia.

DESIGN

The study employed a 2 x 3 single-blind, randomized control group design with two study conditions, FVEP or usual care (UC), and three times of measurement, baseline, 3-months, and 6-months.

SETTING

The study was conducted in five skilled-care nursing homes that ranged in size from 120 to 300 beds.

PARTICIPANTS

Sixty-six residents with dementia and their primary visitor were randomly assigned to FVEP (n = 32) or UC (n = 34).

MEASUREMENTS

Residents were assessed for (1) psychosocial functioning, (2) depression, (3) agitated behavior, and (4) degree of positive social interaction. Nursing staff were assessed for changes in the time and methods used to manage problem behaviors. Visitors were assessed for (1) dementia management skills, (2) extent of perceived caregiving hassles, and (3) visit satisfaction.

RESULTS

FVEP was effective for reducing residents' problem behaviors and for decreasing their symptoms of depression and irritability. It was also effective for improving the way family members and other visitors communicated with residents, but, with the exception of reducing the use of mechanical restraints, it was not effective in changing nurses' management of residents' behavior problems.

CONCLUSIONS

It is possible to educate family members to communicate and interact more effectively with nursing home residents with dementia. This has beneficial effects on residents but not on nursing staff's management of problem behaviors.

Depressive symptoms among spousal caregivers of institutionalized mates with Alzheimer's: boundary ambiguity and mastery as predictors

The goal of this study was to identify factors that predict whether or not community-dwelling spouses experience depressive symptoms upon institutionalization of a mate with Alzheimer's disease. Eighty-four community-dwelling spouses (50 wives/34 husbands) completed questionnaires. Boundary ambiguity alone accounted for 51% of the variability in the depressive symptoms score, while mastery alone was found to account for 32%. The total explained variance, when controlling for demographic variables, was 68%. In the stepwise regression analysis, it was observed that mastery did not add significantly to the explanation of the depressive symptom score over and above boundary ambiguity. However, boundary ambiguity and mastery were somehow linked together and were powerful in explaining caregiver symptoms of depression. If a goal is to keep caregivers healthy, then interventions and education about how to live with ambiguity and how to be masterful in spite of the ambiguous status of one's mate seem necessary. Clinical implications are discussed. Future research might build upon this study's limitations for an even better understanding of factors that relate to caregiver depressive symptoms.

Caring for demented people in their homes or in sheltered accommodation as reflected on by home-care staff during clinical supervision sessions

This study aimed to illuminate both the content of and the care given to demented people and the reflections of home care staff about it as revealed in two clinical group supervision sessions (n = 36). Verbatim transcriptions were analysed using a phenomenological hermeneutic approach and the following were found to be reflected on: the pensioners' personal situation--disease-related behaviour, ADL-functions, social network and self-esteem; the pensioners' environment--their relationships to significant others, adequate level of housing/care, access to activities, and satisfactory personal space; pensioner/staff interaction--their relations to each other, the staffs' relation to the pensioners' family, and the balance between reality-orientation vs. validation; the staff's situation--co-operation with other professionals, in primary health care, hospital, and within the social services; job satisfaction, lack of knowledge and sharing of knowledge, and lack of resources, especially time. The reasoning of the participants under supervision was found to be based on medical, historical, psychological, and environmental explanations, or personal beliefs. Feelings explored during supervision were directed towards the pensioners or the pensioners' families, towards themselves or towards the management. The findings were interpreted within a nursing model based on the four central concepts of nursing; person, environment, nursing intervention and health. The reasoning about nursing care revealed in the supervision sessions reflected a holistic approach and the relationship between the staff and the demented person stood out as central for care quality. Thus focusing on what promotes or, respectively, obstructs this relationship is likely to be one important focus in clinical supervision not only to achieve improvement and high quality in home care but also to develop and enhance the quality of the working life of the staff. Since the results could be understood within a theoretical nursing care model, it may well be that if the supervisor functions within some theoretical model the participants may reach a more conscious approach and the risk of losing important aspects of caring will decrease.