Turkish Adult Children as Caregivers of Parents with Alzheimer's Disease: Perceptions and Caregiving Experiences

Moral aspects of filial concern for a parent living with dementia: Social imaginaries in contemporary narratives

Many adults face the difficulties of a parent living with dementia. Although not always caregiving for a parent living with dementia, they care about and are concerned for the vulnerability of their parent. This concern is invaluable but often an experience with a far-reaching impact. Qualitative research on filial concerns and experiences of caregiving has resulted in a vast body of knowledge about the experience of family carers. Far less research, however, has examined the moral concern of children. The aim of this study is to gain insight into the normative aspects of their concern. An international collection of 24 books written by adult children about their involvement with an ageing parent was analysed using the Dialogical Narrative Analysis method. Our study shows that the stories deal with children's moral questions about independence, identity, and suffering. These questions can be related to social imaginaries of individualism and progress. The two social imaginaries may have both positive and negative impacts on children's ability to cope with their concern for a parent living with dementia. The moral questions that arise from children's concern seem to originate from both the appeal of the vulnerable parent and from the social imaginaries. These moral sources may compete, resulting in moral friction. Children with a parent living with dementia deliberate upon the personal and societal held beliefs and need moral space to embody their concern.

Cross-country variations in the caregiver role: evidence from the ENTWINE-iCohort study

BACKGROUND

Globally, economically developed countries face similar ageing demographics and the challenge of a 'care gap', yet they vary due to different care and formal support systems, and different cultural and societal norms around illness and care. The aim of this exploratory study was to examine cross-country variations in caregiver motivations, willingness, values, meaning in life, illness beliefs, and experiences of wellbeing, gain, health-related quality of life, burden and depression, across 6 European countries and Israel. Cross-country differences in the above-mentioned informal caregiver experiences are rarely described.

METHODS

An online survey (ENTWINE-iCohort) was conducted using validated measures wherever possible. This paper utilises data from 879 caregivers and seven countries (Greece, Italy, the Netherlands, Poland, Sweden, the UK, and Israel).

RESULTS

No consistent finding supporting the concurrent relationship between caregiver support policies/country culture and caregiver motivations/willingness was found. Caregivers in countries typically characterised by individualist cultures reported lower familism, higher self-enhancement values, and greater perceived illness threat compared to more collectivist countries. Search for meaning was higher in poorer countries than in wealthier countries. Higher negative caregiver experiences (e.g., burden) and lower positive experiences (e.g., wellbeing) were generally observed in countries with underdeveloped caregiver support as compared to countries with more developed formal support systems.

CONCLUSIONS

Cross-country variations can be explained to varying degrees by national policies around care (or their absence) and country cultural contexts. The results emphasise the importance of formal support services for achieving positive caregiver experiences, and help inform the development of policies and measures to support caregivers in Europe and Israel.

Attitudes toward pre-symptomatic screening for Alzheimer's dementia in five European countries: a comparison of family members of people with Alzheimer's dementia versus non-family members

Introduction: Pre-symptomatic screening is getting more attention in healthcare as it detects the risk for developing neurodegenerative diseases like Alzheimer's disease (AD), which is very useful for treatment or prevention. AD screening could play an important role in individuals with at least one affected first-degree relative, but also without family history. As the demand for screening is rising worldwide, it is important to consider possible cross-cultural differences in attitudes toward pre-symptomatic screening in order to tailor healthcare services to the needs of each country. Objective: This study aims to investigate the attitudes of family members and non-family members of people with dementia toward pre-symptomatic screening and explore possible differences in attitudes across five European countries (Belgium, Germany, Greece, Spain, Turkey) using translated versions of the "Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening" questionnaire (PRE-ADS). Methods: The multicultural sample (N = 650) was recruited from samples that were previously used in validation studies of the translated PRE-ADS versions. The subscale "Acceptability of Screening", consisting of five PRE-ADS items to specifically explore willingness to undergo screening, was created. Ιnternal consistency was measured, and structural validity was determined using Confirmatory Factor Analysis (CFA). Group comparisons were performed to investigate differences in attitudes toward pre-symptomatic AD screening regarding family history and country of origin using the PRE-ADS and the "Acceptability of Screening" mean scores. Results: Construct validity was acceptable for the PRE-ADS. Both the PRE-ADS (α = 0.76) and its subscale "Acceptability of Screening" (α = 0.90) had good internal consistency. Overall, 56.9% of the total sample expressed a positive intention toward pre-symptomatic AD screening. T-tests showed significantly higher mean scores of participants with an affected family member. An international comparison revealed differences in the "Acceptability of Screening" mean score across the five European countries. No cross-cultural differences were found for the PRE-ADS mean score after adjusting for confounding variables. Conclusion: The PRE-ADS and its subscale are reliable tools for assessing pre-symptomatic AD screening attitudes. Variations in the acceptability of screening seem to be linked to family history and cultural influences. Further research with larger samples is needed to explore underlying relationships.

"Embracing The Faith": The Contribution of Islamic Beliefs on the Provision of Care for People with Parkinson's Disease in New Zealand and Indonesia

This study examines the impact of Islamic beliefs on the caregiving practices of individuals diagnosed with Parkinson's disease in Indonesia and New Zealand. The study sample comprised seventeen caregivers who participated in semi-structured interviews which were analysed using the method of inductive thematic analysis. The study delineated three overarching themes: value-driven caregiving, comprehensive care and caregivers strengthened by faith and practice. This study examined the practical applications of the Quran, Hadith and Muslim beliefs in caregiver experiences. Further research is necessary to enhance the support systems for Muslim caregivers in various circumstances, facilitating the advancement of solutions to contemporary social problems.

Experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries: a systematic review and meta-synthesis

BACKGROUND

The cultural and religious beliefs and values of family caregivers of people with dementia have a profound impact on the use of dementia care services in high-income countries. Yet, little is known about how caregivers of people with dementia from a Muslim migrant background in high-income countries perceive their caregiving journey.

AIM

To synthesise findings from rigorous qualitative studies on the experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries.

METHODS

Meta-ethnography of qualitative studies was applied to address the aim. Five databases including MEDLINE, CINHAL, PsycINFO, Web of Science and Scopus were searched. Inclusion criteria were qualitative or mixed study design studies on family caregivers of people with dementia from a Muslim migrant background in a home care setting in high-income countries. Studies were excluded if they used a quantitative research design, were not written in English and were not original studies.

FINDINGS

In total 17 articles met the inclusion criteria and were included in the study. Meta-synthesis of the data revealed three themes from the life course intersectionality perspective: caregiving as both positive and negative experiences; factors affecting caregivers' experiences; and coping strategies used by caregivers.

CONCLUSION

Caregivers of people with dementia from a Muslim migrant background living in high-income countries have both positive and negative caregiving experiences. However, dementia care services were not tailored to address their care needs and expectations arising from their religious and cultural beliefs.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

We conducted a qualitative study using semi-structured interviews.

SETTINGS

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

PARTICIPANTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Resilience in Family Caregivers of Asian Older Adults With Dementia: A Concept Analysis

Asian family caregivers of older adults with dementia have stressful caregiving situations over long periods; they must become resilient to recover from adversity. A conceptual definition of resilience specific to Asian family caregivers is important for understanding their caregiving phenomena and the relationships with mental health and psychological well-being. The purpose of this concept analysis was to define resilience in family caregivers of Asian older adults with dementia using Walker and Avant's method. The findings of the analysis will guide future research about the modifiable factors that will prevent negative health outcomes in this population of caregivers.

Care arrangements between family and state – developing hybrid scripts of ageing in a context of migration

Due to demographic developments, the number of immigrant families with older members is growing across Western Europe. Poised between the different approaches to care in their countries of origin and destination, such families are treading new ground as they negotiate support for older family members. Based on semi-structured interviews with 26 older and younger family members from 20 Turkish immigrant families in Denmark, this article investigates the broad variation in how these families approach caring for older people. At one end of the scale, some families (re)create a traditional Turkish approach to care in which three generations live together and the daughter-in-law is the main care provider. At the other end of the scale, some families follow the Danish approach in which families rely on public care provision. In between these two poles, many families devise a variety of care solutions for their older members that often rely on considerable support by family. Utilising Cati Coe's concept of care-scription, the analysis shows how families negotiate – and sometimes struggle over – who will shoulder which tasks. In the post-migration context, daughters-in-law are often able to retreat from their traditional role of care provider, which in turn increases expectations of daughters' care provisions. In Denmark, which is a relatively gender-equal society, Turkish daughters may seek to make their brothers take on a greater role in the provision of care for their parents, and in some families, the children also turn towards public care provisions to share the burden of parental care. Resistance from older parents may, however, short-circuit this strategy. Overall, the study points both to the difficulties faced by older immigrants with limited host-country language proficiency when utilising public European care provisions and to the complex and unsettled nature of care provisions in immigrant families in Europe today.

Care burden and related factors among informal caregivers of patients with amyotrophic lateral sclerosis

Objective: Amyotrophic lateral sclerosis (ALS) affects the life of the family caregiver as well as the patient. This study aimed to determine the care burden and related factors among family caregivers of Turkish ALS patients. Methods: This descriptive study was conducted with 108 ALS patients and their informal caregivers through face-to-face interviews at home. The data were collected using the ALS Functional Rating Scale, Zarit Burden Interview, European Quality of Life-Five Dimensions Questionnaire, Multidimensional Scale of Perceived Social Support, and the Hospital Anxiety and Depression Scale. Results: The mean age of the caregivers was 48.1 ± 13.4 years; the vast majority were female, and they were either spouses or children of the patients. While 49.1% reported moderate or severe burden, the quality of life was moderate (mean 70.4 ± 22.8). The caregiver burden was related to sex and the functional state of the patient, as well as caregiver factors such as the relation to the patient, sex, health status, time spent for care, and living in the same house with a limited environment. Walking ability, percutaneous endoscopic gastrostomy, tracheostomy, and communication problems were not associated with the burden. Furthermore, burden was associated with the caregiver's quality of life, social support, anxiety, and depression. Conclusions: The present study draws attention to the fact that the care burden in family caregivers of ALS patients is high and their quality of life is impaired. Our findings reveal that not only ALS patients but also caregivers need to be supported with an organized and planned system.

Focused Attention on Positive Aspects of Dementia Care in Culturally and Linguistically Diverse Communities: Qualitative Insights from Australia

OBJECTIVES

Dementia care scholarship focuses on care challenges and less on positive aspects of care, especially among culturally and linguistically diverse (CALD) carers outside the United States. This article investigates positive aspects of dementia care across eight CALD groups in Australia.

METHODS

We analyzed interviews of 112 family carers using a four-domain framework covering: a sense of personal growth, feelings of mutuality, increases in family cohesion, and a sense of personal accomplishment.

RESULTS

Positive associations with care are derived from past relationships, feelings of mutual obligation, valuing changed relationships and enjoying spending time with the person with dementia. Positive aspects of care were not associated with increased family cohesion except in Vietnamese and Arab families; neither was use of ethno-specific residential aged care, except for Greek and Italian families. Religion and spirituality as a coping and comforting mechanism was inconsistently expressed.

CONCLUSIONS

The study reveals the multi-dimensional nature of care, what resonates, and diverges across CALD populations. Knowing which parts of the framework apply and which do not is useful for interventions seeking to enhance positive aspects of care.

CLINICAL IMPLICATIONS

Migrant populations are varied and dynamic, and practitioners should be mindful of differences within and between ethnic minority groups.

Factors associated with positive aspects of caregiving experiences among family caregivers of persons living with dementia in Taiwan: A cross-sectional study

This study examined the associated factors of positive aspects of caregiving experience among family caregivers of persons living with dementia in Taiwan. This cross-sectional correlational study recruited dyads of primary family caregivers of persons living with dementia by convenience sampling from dementia care centers in northern Taiwan from September 9, 2020, to June 20, 2021. A total of 100 dyads who met inclusions criteria agreed to participate in the study. Significant predictors of positive aspects of caregiving experience were scores of dementia behavior disturbance (t=-3.63, p =<.001), a spousal caregiver (t=2.83, p =.006), and the subscale score for satisfaction on the functional social support (t=2.62, p =.01). Our findings suggest prevention and treatment of dementia behavior disturbance for persons living with dementia, improving satisfaction with functional social support, and focusing on non-spousal caregivers could enhance experiences of positive caregiving for family caregivers.

The positive aspects of caregiving in dementia: A scoping review and bibliometric analysis

Purpose

The increasing incidence of dementia and home-based care exposes family caregivers to a variety of challenges as they endure strong stressors underlying the caregiver role. Despite growing publications on positive aspects of caregiving in dementia, few studies have identified the extent, nature, and gaps in the existing literature based on a holistic view. The aim was to identify key issues and a holistic view of literature regarding positive aspects of caregiving in dementia.

Methods

A scoping review was conducted underlying a five-stage framework by Arksey and O'Malley. Five databases, including PubMed, CINAHL, PsycINFO, Embase, and Web of Science, were searched, and references were listed accordingly. Data were extracted by two researchers, comprising article characteristics, forms of positive aspects of caregiving and measurements, theories, forms of dementia and family caregiver, and keywords. Descriptive statistics and narrative synthesis were performed to analyze data. Network analysis of keywords and authors was conducted using VOSviewer software. Word cloud analysis of titles was examined by NVivo.

Results

The review included 230 articles, most of which have been published in the last decade (62.61%). Most articles (40.00%) were contributed by the United States. Cross-sectional studies (41.30%) ranked first, followed by qualitative studies (13.48%). Over a quarter of the literature (28.26%) focused on Alzheimer's care, and nearly 90% included all forms of family caregivers. The Positive Aspects of Caregiving Scale and stress coping theory were most frequently cited. Four clusters dominated by Casey D, Quinn C, Joling KJ, and Teahan A were identified in the network of co-authorship. Six themes were identified: current situations of caregiver experiences, antecedents, consequences, measurement development, effects of interventions, and the concept of positive aspects of caregiving. These were in line with network analysis of keywords and word cloud analysis of titles.

Conclusions

Positive aspects of caregiving in dementia have been widely concerned, but most of them are based on the theory of the negative stress process and are limited to current situations and influencing factors. Building theories focus on the positive aspects of caregiving, subsequently developing a comprehensive measurement and effective interventions, should be further studied.

Psychological distress in sons as resident carers of older mothers in Japan

In Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.

Normative tensions in filial caring for a mother with dementia: A narrative perspective

This article aims to gain insight in the normative struggles of adult children caring for their ageing mother living with dementia. Two Dutch autobiographical books written by siblings recording their own caregiving experience were analysed using a narrative design. Children appear to understand their normative concerns through six fields of tension. Our analysis shows that filial caregivers describe two distinct approaches to deal with these normative tensions. One approach aims to preserve the child's pre-existing personal beliefs and values, but also causes the child to demonstrate rigid and uncompromising behaviour at odds with the needs of their parent. The other approach is more reflective and flexible, prioritizing the needs of the vulnerable person over previously held values, providing an opportunity for better care. We conclude that caregiving children have to find their way between being faithful to their principles and showing moral flexibility.

The experiences of family caregivers of people with severe mental illness in the Middle East: A systematic review and meta-synthesis of qualitative data

Background

There is a wealth of literature exploring the experiences of family caregivers of people with severe mental illness (SMI) in western countries, however, this topic has been neglected in the Middle East, despite families being the main source of caregiving in this context. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis to explore the experiences of family caregivers living in countries in the Middle East caring for a relative with severe mental illness.

Methods

A systematic review and meta-synthesis were conducted, to comprehensively gain a thorough and detailed overview of what is known about family caregivers’ experiences from published qualitative research in the Middle East geographical area from inception to May 2021. The review protocol was pre-registered with PROSPERO (Ref: CRD42020165519).

Results

The review identified twelve qualitative studies that explored caregivers’ experiences of caring for relatives with SMI in Middle East countries. Family caregivers’ experiences were captured under seven overarching themes. The participants across all studies reported negative consequences of providing care, increased burden and emotional distress. Many experienced issues with family/marital relationships and stigmatizing attitudes and behaviours from their communities. Caregivers expressed the need for increased support which was perceived to have a critical role in improving family caregivers’ experiences.

Conclusions

The meta-synthesis revealed many challenges and issues that affect caregivers of people with SMI in the Middle East. Family caregivers experienced distress and burden, and reported significant impact on their psychological well-being. Their experiences highlight the urgent need to provide more support for family caregivers in Middle East countries.

Effects of an educational peer-group intervention on knowledge about dementia among family caregivers with a Turkish or Moroccan immigrant background: A cluster randomised controlled trial

OBJECTIVE

The aim of this paper is to examine the effects of an educational peer-group intervention on knowledge about dementia, perceived ability to talk about it, received support and self-perceived pressure from informal care among family caregivers with a Turkish or Moroccan immigrant background who cared for a person with dementia.

METHODS

This paper is based on a cluster randomised controlled trial with three measures, including participants who knew or cared for a person with dementia. For the purpose of this study, a selection was made of participants who cared for a person with dementia. Knowledge about dementia, perceived ability to talk about dementia, support received and self-perceived pressure from informal care were assessed inthe intervention and the control condition. Multi-level analyses were conducted to examine the effects.

RESULTS

Data for 386 participants was analysed. Improvement in knowledge about dementia over time was significantly greater in the intervention condition than in the control condition. In the intervention condition, there was also a significant increase over time in the support received from home-care staff, which was not found in the control condition. No effects were found on other types of support received, the ability to talk about dementia or the self-perceived pressure from informal care.

CONCLUSION

Offering a culturally sensitive educational peer-group education intervention enhances knowledge about dementia and has a small but positive effect on the support received from home-care staff in these groups.

PRACTICE IMPLICATIONS

Offering peer-group-based education about dementia to family caregivers with Turkish or Moroccan immigrant backgrounds is important for multicultural dementia care.

A Pilot Study on the Efficacy of Stress Relief Programs for Family Caregivers of Older People with Dementia

The aim of this study was to evaluate the effects of stress-relief programs on positive aspects of caregiving and depression among caregivers of older people with dementia. A quasi-experimental design was employed. Participants in the experimental group received a 8-week period and 120 minutes each session cognitive-behavioral therapy. Participants in the control group received standard health education. Stress relief programs may alleviate depression and increase positive aspects of caregiving among family caregivers of older people with dementia. These findings will help health professionals to implement stress-relief strategies for family caregivers of older people with dementia, or to use those strategies to increase positive aspects of caregiving, or to alleviate depression in caregivers.

Experiences on Providing Home Care for A Relative with Heart Failure: A Qualitative Study

PURPOSE

The aim of this study was to explore and describe the lived experiences of persons providing home care for community-dwelling relative with heart failure (HF) in Jordan. Design: It was a phenomenological study. Methods: Data were collected through interviews with 29 participants and analyzed using a thematic analysis approach. Findings: Four core themes have emerged: caregiving as a mandatory responsibility, positive experiences, negative experiences, and factors influencing the quality of the experiences. Conclusion: Although the hallmark of the participants' experience was negative, they showed a strong commitment to caring for their ill relatives. Clinical Evidence: The findings underscore the need for frequent assessment and support of family caregivers.

Caregiving for ageing parents: A literature review on the experience of adult children

BACKGROUND

More and more adults in their fifties and sixties are confronted with the need to support their ageing parents. Although many aspects of filial caregiving have been researched, a well-documented and comprehensive overview of the caregiving experience is lacking.

AIM

This study aims for a better understanding of the caregiving experience of adult children by generating an overview of main themes in international research.

METHOD

A literature review of qualitative studies, focusing on the experiences of adult children caring for their ageing parents, was performed. The electronic EBSCO databases Academic Search Premier, CINAHL and PsycINFO, and Google Scholar were searched to identify relevant qualitative studies published between 2000 and 2017. The 'SPIDER' eligibility criteria directed the approach. The quality of studies included was screened with the assessment sheet designed by Hawker and colleagues. The experiences reported were analysed and themes were synthesized.

ETHICAL CONSIDERATION

Ethical requirements were respected in every phase of the research process.

FINDINGS

Nineteen qualitative studies met the inclusion criteria. The quality of the relationship with the parent appears to be an important determinant of the children's caregiving experience. Within this context, three themes were found: caregiving as an emotional rollercoaster, a normatively demanding experience and an opportunity for personal development.

DISCUSSION

Children caring for their ageing parents have to deal with a wide range of contradicting and conflicting norms and values. Implications for healthcare professionals and future research have been discussed.

CONCLUSION

Caring for ageing parents is a continuous quest for giving the best possible care and living up to one's personal values, within the context of the parent's declining health. Professionals who support filial caregivers should address not only practical responsibilities but also the normative questions and moral considerations caregivers are dealing with.

The Perceived Caregiver Burden Among Turkish Family Caregivers Providing Care for Frail Older Adults

Purpose: The older population has reached to 8.5%, and the prevalence of frailty is reported as 39.2% in Turkey. The purpose of the study was to assess caregiver burden in families who care for frail older adults in Turkish culture. Method: This descriptive study was conducted in Turkey between June and October 2017. Frail older adults who had no severe cognitive impairment were included. Data were measured using the Older Adult Information Form, Edmonton Frailty Scale, Caregiver Information Form, and Zarit Burden Interview. Results: In total, 131 older person/caregiver dyads were analyzed; the Zarit Burden Interview mean score was 37.59 ± 18.20. Caregivers with less education and providing care more than 8 hours experienced a higher burden ( p < .05). The severity of frailty significantly correlated with the caregiver scores ( R = .36, p < .01). Conclusion: The caregiver burden in Turkish family caregivers was found mild to moderate and correlated with the degree of frailty. Policymakers should focus on culture-specific formal caregiver services.