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Choi J, Ta Park V, Nguyen E, Jung A, Tsoh J. Understanding the caregiving experiences of Asian Indian, Chinese, Korean, and Vietnamese American family care partners of persons living with dementia. Aging Ment Health 2024; 28:473-481. [PMID: 37655598 DOI: 10.1080/13607863.2023.2252772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES Disparities impacting dementia health care exist in racial/ethnic minority groups, including Asian Americans, an understudied population in Alzheimer's disease and related dementias. The qualitative study explored caregiving experiences and potential cultural influences among Asian Indian, Chinese, Korean, and Vietnamese family care partners of persons living with dementia. METHODS We conducted focus groups and individual interviews with 32 care partners from these four Asian subgroups using Zoom, WeChat, or telephone. RESULTS Four themes emerged from the data: (1) Family obligations influencing caregiving decisions; (2) Evolving challenges related to dementia caregiving; (3) Caregiving burdens/negative impacts from caregiving (relationship burdens and emotional distress); and (4) Coping with their situation in their own ways (cognitive, behavioral, and social strategies).Conclusion: Cultural values (e.g. familism or filial piety) played a significant role in caregiving decisions and experiences. There was a need to raise public awareness of dementia and create culturally and linguistically appropriate training programs for this population.
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Affiliation(s)
- JiWon Choi
- Institute for Health & Aging/Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Van Ta Park
- Community Health Systems, School of Nursing, UCSF, San Francisco, CA, USA
| | | | - Andrew Jung
- School of Public Health, University of California, Los Angeles, CA, USA
| | - Janice Tsoh
- Psychiatry & Behavioral Sciences, School of Medicine, UCSF, San Francisco, CA, USA
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Pérez-González A, Vilajoana-Celaya J, Guàrdia-Olmos J. Burden and anticipatory grief in caregivers of family members with Alzheimer's disease and other dementias. Palliat Support Care 2023:1-11. [PMID: 37795789 DOI: 10.1017/s1478951523001360] [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: 10/06/2023]
Abstract
OBJECTIVES This study aimed to analyze the different factors that intervene in the task of caring for relatives of people with Alzheimer's and other dementias. A first objective focused on assessing the relation between burden and anticipatory grief, considering the possibility of social support and the risk of psychopathology. A second objective aimed to examine whether caregiver burden modulates the relationships between anticipatory grief and psychopathology. A cross-sectional design was employed. METHODS The sample consists of 129 participants who care for a family member with Alzheimer's and other dementias. A protocol based on a battery of tests has been applied and a mediation analysis was carried out. RESULTS The results show a positive relationship between burden and anticipatory grief. Social support could have an indirect relationship with anticipatory grief, based on its effect on the level of psychopathology and caregiver burden. Finally, a modulation model reflects that the relationship between anticipatory grief and psychopathology is strong, the latter having a greater effect as a result variable than as a risk variable. However, it seems that the relationship between grief and psychopathology is better explained directly than not through the modulating effect of the caregiver burden. SIGNIFICANCE OF RESULTS The results obtained encourage us to think that an approach focused on intervening in the anticipatory grief may be an opportunity to reduce or buffer other caregiving outcomes, especially those related to the perception of caregiver burden and psychopathology.
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Affiliation(s)
- Alba Pérez-González
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Joan Guàrdia-Olmos
- Research group of Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
- Institute of Complex Systems, University of Barcelona, Barcelona, Spain
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Liebzeit D, Jaboob S, Bjornson S, Geiger O, Buck H, Arbaje AI, Ashida S, Werner NE. A scoping review of unpaid caregivers' experiences during older adults' hospital-to-home transitions. Geriatr Nurs 2023; 53:218-226. [PMID: 37598425 DOI: 10.1016/j.gerinurse.2023.08.010] [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: 07/12/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
The objective of this scoping review is to examine current evidence regarding unpaid/family caregivers' experiences during older adults' hospital-to-home transitions to identify gaps and opportunities to involve caregivers in transitional care improvement efforts. Eligible articles focused on caregiver experience, outcomes, or interventions during older adults' hospital-to-home transitions. Our review identified several descriptive studies focused on exploring the caregiver experience of older adult hospital-to-home transitions and caregiver outcomes (such as preparedness, strain, burden, health, and well-being). Qualitative studies revealed challenges at multiple levels, including individual, interpersonal, and systemic. Few interventions have targeted or included caregivers to improve discharge education and address support needs during the transition. Future work should target underrepresented and marginalized groups of caregivers, and caregivers' collaboration with community-based services, social networks, or professional services. Work remains in developing and implementing interventions to support both older adult and caregiver needs.
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Affiliation(s)
- Daniel Liebzeit
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA.
| | - Saida Jaboob
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Samantha Bjornson
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Olivia Geiger
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Harleah Buck
- The University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA
| | - Alicia I Arbaje
- Department of Medicine, Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicole E Werner
- Indiana University School of Public Health- Bloomington, Bloomington, IN, USA
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Fields B, Werner N, Shah MN, Hetzel S, Golden BP, Gilmore-Bykovskyi A, Farrar Edwards D. Adapting and Testing the Care Partner Hospital Assessment Tool for Use in Dementia Care: Protocol for a 2 Sequential Phase Study. JMIR Res Protoc 2023; 12:e46808. [PMID: 37347517 DOI: 10.2196/46808] [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: 02/26/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Research and policy demonstrate the value of and need for systematically identifying and preparing care partners for their caregiving responsibilities while their family member or friend living with dementia is hospitalized. The Care Partner Hospital Assessment Tool (CHAT) has undergone content and face validation and has been endorsed as appropriate by clinicians to facilitate the timely identification and preparation of care partners of older adult patients during their hospitalization. However, the CHAT has not yet been adapted or prospectively evaluated for use with care partners of hospitalized people living with dementia. Adapting and testing the CHAT via a pilot study will provide the necessary evidence to optimize feasibility and enable future efficacy trials. OBJECTIVE The purpose of this paper is to describe the study protocol for the adaptation and testing of the CHAT for use among care partners of hospitalized people living with dementia to better prepare them for their caregiving responsibilities after hospital discharge. METHODS Our protocol is based on the National Institutes of Health Stage Model and consists of 2 sequential phases, including formative research and the main trial. In phase 1, we will use a participatory human-centered design process that incorporates people living with dementia and their care partners, health care administrators, and clinicians to adapt the CHAT for dementia care (ie, the Dementia CHAT [D-CHAT]; stage IA). In phase 2, we will partner with a large academic medical system to complete a pilot randomized controlled trial to examine the feasibility and estimate the size of the effect of the D-CHAT on care partners' preparedness for caregiving (stage IB). We anticipate this study to take approximately 60 months to complete, from study start-up procedures to dissemination. The 2 phases will take place between December 1, 2022, and November 30, 2027. RESULTS The study protocol will yield (1) a converged-upon, ready-for-feasibility testing D-CHAT; (2) descriptive and feasibility characteristics of delivering the D-CHAT; and (3) effect size estimates of the D-CHAT on care partner preparedness. We anticipate that the resultant D-CHAT will provide clinicians with guidance on how to identify and better prepare care partners for hospitalized people living with dementia. In turn, care partners will feel equipped to fulfill caregiving roles for their family members or friends living with dementia. CONCLUSIONS The expected results of this study are to favorably impact hospital-based care processes and outcomes for people living with dementia and their care partners and to elucidate the essential caregiving role that so many care partners of people living with dementia assume. TRIAL REGISTRATION ClinicalTrials.gov NCT05592366; https://clinicaltrials.gov/ct2/show/NCT05592366. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46808.
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Affiliation(s)
- Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Scott Hetzel
- Department of Statistics, School of Computer, Data and Information Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Blair P Golden
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Dorothy Farrar Edwards
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, United States
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Fields B, Still C, Medlin A, Strayer A, Arbaje AI, Gilmore-Bykovskyi A, Werner N. Care Partner Inclusion of People Hospitalized With Alzheimer Disease and Related Dementias: Protocol for a Mixed Methods Systems Engineering Approach to Designing a Health Care System Toolkit. JMIR Res Protoc 2023; 12:e45274. [PMID: 37191978 PMCID: PMC10230354 DOI: 10.2196/45274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Research and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners' active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. OBJECTIVE This paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. METHODS The A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. RESULTS The A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. CONCLUSIONS We anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45274.
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Affiliation(s)
- Beth Fields
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Catherine Still
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Austin Medlin
- Department of Design & Wellness, Indiana University, Bloomington, IN, United States
| | - Andrea Strayer
- College of Nursing, University of Iowa, Iowa City, IA, United States
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Andrea Gilmore-Bykovskyi
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Nicole Werner
- Department of Design & Wellness, Indiana University, Bloomington, IN, United States
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Liebzeit D, Fields B, Robinson EL, Jaboob S, Ashida S. A qualitative study of unpaid caregivers of persons living with dementia and their interactions with health and community-based services and providers. DEMENTIA 2023; 22:328-345. [PMID: 36534394 DOI: 10.1177/14713012221146253] [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: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Unpaid caregivers frequently feel underprepared and without adequate training, support, or access to services and resources to care for persons living with dementia. Health and community-based services and providers are critical to support persons living with dementia and their unpaid caregivers. The objective of this research is to understand how unpaid caregivers of persons living with dementia interact with health and community-based services and providers. RESEARCH DESIGN AND METHODS We used a qualitative descriptive approach to analyze data from one-on-one semi-structured interviews with unpaid caregivers of persons living with dementia (N = 25). We used framework analysis to organize themes and sub-themes within the systems approach to healthcare delivery. FINDINGS Participants described a need for additional guidance, information, and support from health and community-based services and providers. This need was described by participants at 4 levels: individual, care team, organization, and political and economic environment. Participants were active in proposing potential solutions to challenges at all 4 levels, including improving provider awareness and training in dementia, opportunities to provide resources and referrals upon dementia diagnosis, a central clearinghouse for information and resources for persons living with dementia and caregivers, and opportunities to close service gaps. DISCUSSION AND IMPLICATIONS Findings of this study highlight the need for increased involvement of caregivers of persons living with dementia as community stakeholders for improving care and services. Recommendations to promote high quality care and better support unpaid caregivers by developing interventions to address multiple aspects of healthcare delivery are consistent with recent legislation and are important areas of future research.
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Affiliation(s)
- Daniel Liebzeit
- 16102The University of Iowa College of Nursing, Iowa City, IA, USA
| | - Beth Fields
- Department of Kinesiology, 5228University of Wisconsin-Madison School of Education, Madison, WI, USA
| | - Erin L Robinson
- School of Social Work, 14716University of Missouri, Columbia, MO, USA
| | - Saida Jaboob
- 16102The University of Iowa College of Nursing, Iowa City, IA, USA
| | - Sato Ashida
- Department of Community and Behavioral Health, RinggoldID:%204083The University of Iowa College of Public Health, Iowa City, IA, USA
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Duggleby W, O'Rourke HM, Baxter P, Nekolaichuk C, Thompson G, Peacock S, Ghosh S, Holroyd-Leduc J, McAiney C, Dubé V, Swindle J, Pagnucco-Renaud M, Sana S. Building a new life: a qualitative study of how family carers deal with significant changes. BMC Geriatr 2022; 22:551. [PMID: 35778694 PMCID: PMC9248114 DOI: 10.1186/s12877-022-03236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Family carers of persons living with dementia who are residing in long term care (LTC), often experience significant changes in their roles and relationships which affects mental and physical health. Research has focused on describing the carers’ experience, but not on how they deal with these changes or their perceptions of support needs. The purpose of this study was to explore how family carers of persons living with dementia residing in LTC deal with significant changes and to understand how best to support these carers. Methods Eight face-to-face audio-recorded focus group interviews were conducted with 45 participants from September 2019 to January 2020, as part of a larger study aimed at guiding the adaptation of an online toolkit to support family carers of persons living with dementia residing in LTC. Applied thematic analysis was used to analyze the focus group data. Findings/results Carers dealt with the significant changes they experienced through the process of “building a new life” consisting of two sub-processes: a) building new relationships (with their family member, LTC staff and others outside of LTC), and b) finding space for themselves (sharing of care and finding balance). Understanding dementia, support from others (staff, family and friends), connecting with resources, and being included in care decisions helped carers build a new life. Conclusion The process of building a new life describes the ways that family carers deal with the life-altering changes they experienced when a family member is admitted to LTC. Carers may be supported in building their new life, by providing them with information about dementia and how to relate to staff and their family member living with dementia. The quality of care being provided and the LTC environment may also play an important role in how carers deal with the significant changes they experience.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing University of Alberta, 4-141 ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada.
| | - Hannah M O'Rourke
- Faculty of Nursing University of Alberta, 4-141 ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada
| | - Pamela Baxter
- Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, L8S4K1, Canada
| | - Cheryl Nekolaichuk
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6L 0A3, Canada
| | - Genevieve Thompson
- College of Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Sunita Ghosh
- Alberta Health Services-Cancer Control Alberta, Department of Medical Oncology, University of Alberta, 11560 University Ave, Edmonton, AB, T6G 1Z2, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB, T2N 4W4, Canada
| | - Carrie McAiney
- Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, 200 University Ave, W, Waterloo, ON, N2L 3G1, Canada
| | - Véronique Dubé
- Chairholder Marguerite-d'Youville Research Chair, Faculty of Nursing, University of Montreal, P.O. Box 6128, Centre-ville Station, Montreal, QC, H3C 3J7, Canada
| | - Jennifer Swindle
- Faculty of Nursing, University of Alberta, Level 3 ECHA, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Madeleine Pagnucco-Renaud
- Faculty of Nursing University of Alberta, 4-005A, ECHA, 11405 87th Ave, Edmonton, AB, T6G 1C9, Canada
| | - Samina Sana
- Faculty of Nursing, School of Public Health, University of Alberta, Edmonton, Canada
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