Understanding the lived experiences of family caregivers of individuals with dementia in Soweto, a South African Township

Neglect of older adults living with dementia in family caregiving: A dimensional concept analysis

OBJECTIVE

To present a concept analysis of neglect, specifically examining its occurrence and implications in the context of family caregiving for older adults living with dementia.

METHODS

A literature search was conducted in Medline, CINAHL, Scopus, and Embase databases in February 2023. Inclusion criteria targeted articles focusing on neglect in dementia family caregiving, leading to the identification of 11 articles for thorough review. Employing Caron and Bowers' dimensional analysis approach, the concept analysis aimed to elucidate neglect as a social construct shaped by diverse contexts, perspectives, and underlying assumptions.

RESULTS

Neglect in this context emerged as a multidimensional phenomenon, influenced by contextual elements such as activities of daily living and behavioral symptoms of dementia. It encompasses dimensions including "expectations of unmet needs", "maladaptive behaviors", and "feelings of guilt", considering the perspectives of both caregivers and individuals living with dementia. Recognizing neglect as a dyadic phenomenon emphasizes the significance of interactions between caregivers and individuals living with dementia.

CONCLUSION

A comprehensive understanding of neglect in dementia family caregiving is crucial for effective interventions and support systems. The dyadic perspective is vital for accurate assessment. Primary care physicians, mental health, nurses, and other health professionals play a key role in prevention and supporting family caregivers. Further research is needed to explore the dynamics of dementia caregiving settings strengthening prevention strategies against elder neglect.

Effectiveness of a Patient-Family Carer Partnership Intervention on Blood Pressure Control for People with Hypertension in Rural Communities: A Randomised Controlled Trial

Objectives

To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China.

Design

A randomised controlled trial.

Methods

A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants' health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes.

Results

Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer's dyadic relationship and health-related quality of life at T1 and T2.

Conclusion

The patient-family (carer) partnership intervention has the potential to improve hypertensive people's BP control and family dyad's dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

Giving voice to the voiceless: Understanding the perceived needs of dementia family carers in Soweto, a South African township

This qualitative study aimed to provide family caregivers with an independent platform to reflect on and identify their needs in the role of dementia caregiver. Thirty caregivers were interviewed using a semi-structured approach, and data analysis followed a reflective thematic analysis method. The study revealed that Black African caregivers in townships require sufficient information and orientation to dementia-specific services, psychoeducation on dementia as a disease and its behavioural manifestations, as well as practical skills to manage the disease process. Caregivers expressed the need for in-depth, accessible education to boost their confidence and resilience in handling the challenges of dementia caregiving. They also proposed community initiatives to raise awareness, promote knowledge, and facilitate early detection and diagnosis of dementia. Additional needs included informational and educational workshops, resources like transportation services and helplines, day care facilities, media campaigns, and collaboration with the government for funding and policy change. New caregivers were advised to seek comprehensive education, support, and services while preserving the dignity of their family members with dementia. Remarkably, the identified needs and community initiatives aligned with the priority areas outlined by ADI for a National Dementia Plan, which South Africa currently lacks. The study highlights the importance of developing a National Dementia Plan in South Africa through collaboration among stakeholders, including communities, policy-makers, and multidisciplinary healthcare teams, while ensuring that individuals and families affected by dementia have a voice.

Primary caregivers' experiences of caring for people living with dementia in Ghana: a phenomenological study

BACKGROUND

Dementia is often associated with functional impairments that limit the independence of persons living with dementia (PwD). As such, many PwD often require a higher level of support provided by persons referred to as caregivers. Such caregiving activities tend to strain and stress the caregiver. Nonetheless, Ghana lacks empirical evidence and understanding of the effects of caring for PwD on the lives of primary caregivers. To help narrow this knowledge gap, we explored the perspectives of primary caregivers about the impacts of caring for PwD in Ghana.

METHODS

Using a descriptive phenomenological design, we conducted in-depth interviews with primary caregivers in the Ashanti region, Ghana. A semi-structured interview guide was used as the data collection instrument. The data analysis followed Collazi's thematic analysis framework. All coding and categorization were done in NVivo-12.

RESULTS

Five themes emerged from the analysis. These themes included (a) sacrifice of personal interests, and time commitments; (b) financial strain and negative impact on job; (c) feelings of stress and burnout; (d) experience of abuse and stigma; and (e) perceived blessing of caregiving.

CONCLUSION

The study's findings resonate with existing literature, highlighting the consistent struggles faced by caregivers. Sacrificing personal interests, navigating financial strains, and grappling with stress and burnout emerged as pervasive themes. We conclude that despite the negative impacts of caring for PwD, caregivers perceived their role as associated with blessings, deriving positive meaning and fulfilment from their caregiving journey. This study underscores a need to build more compassionate communities in rural settings of Ghana.

The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review

This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.

Lay Knowledge and Beliefs Toward Dementia Among the Black African Populations in the UK and Africa: Evidence Synthesis of Qualitative Studies

BACKGROUND

The high prevalence of dementia among Black Africans, coupled with their lower engagement with dementia specialist services in the UK, underscores the urgency of understanding lay knowledge and beliefs about dementia in the group. Studies reporting lay knowledge of dementia in the UK tended to conclude that Black Africans lack dementia knowledge, presumably based on biomedical assumptions, without taking into consideration the Black Africans' lay dementia knowledge and beliefs about dementia. The current study, therefore, investigated the Black African populations' lay knowledge and beliefs toward dementia in Africa, comparing how this relates to the findings in the UK literature. Methodology: The researcher thoroughly searched electronic databases from September 2017 to October 2022 for qualitative research exploring how Black African populations perceived and experienced dementia, which informed the Black Africans' dementia knowledge in Africa and the UK. The review included qualitative studies with African populations published in peer-reviewed journals with available abstracts and full text in English. Studies outside the UK and Africa, as well as quantitative research and studies with health practitioners, were excluded. A grounded theory approach informed the thematic analysis. The researcher reported the Black Africans' lay knowledge and beliefs toward dementia, informed by participants' experiences and meanings of dementia. Results: Twenty-two studies (n = 22) met the eligibility criteria and were appraised and included in the review. All the UK papers were a multi-modeling of ethnicity in the study. Nine studies (n = 9) were conducted in the UK. Thirteen studies (n = 13) are conducted in Africa, (5 [n = 5] studies from South Africa, 2 [n = 2] from Tanzania, 1 [n = 1] from Congo, 2 [n = 2] from Uganda, 2 [n = 2] from Nigeria, and 1 [n = 1] from Ghana). All the studies were valuable. The researcher identified and developed 4 themes as they emerged from the studies: (i) Dementia witchcraft paradigm, (ii) Dementia older age paradigm, (iii) Dementia disease and illness paradigm, and (iv) Dementia identity paradigm. Discussion/Conclusion: The lay knowledge and beliefs about dementia among Black African populations were foregrounded in sociocultural distinctiveness, and some understanding intersected with biomedical knowledge about dementia. Further empirical study in the UK is essential. Implications for policy and practice: A better understanding of lay knowledge and beliefs about dementia among Black African populations can improve dementia care, providing culturally sensitive and tailored support for Black African communities.

Navigating the Complexities of Dementia Care: The Lived Experiences of Black American Family Caregivers

Black American individuals have a higher rate of Alzheimer's disease and related dementias (ADRD) diagnoses compared to other racial/ethnic groups, and their family caregiver population is expected to increase rapidly over the next 2 decades. The current study aimed to explore Black American women's experiences caring for family members with ADRD. An interpretative phenomenology approach was used to gain a deeper understanding of the caregiving experiences of Black American women. Participants in the study were all Black American married women aged 63 to 81 years (mean = 71.3 years, SD = 6.6 years). Key themes that emerged from the study included: (a) Family Care Obligation, (b) Caregiving Journey, (c) Prioritizing Health Concerns, (d) Coping Behaviors, and (e) Support Needs and Challenges. Family caregivers require ongoing support, education, and guidance. Implications for nursing practice include focusing on family assessments, increased education and awareness, and collaboration with interdisciplinary teams to provide the best resources. [Journal of Gerontological Nursing, 49(6), 19-26.].

Up-Close and Personal: Conceptualizing the Self as Dementia Caregiver: a Study in Soweto, South Africa

The aim of this study was to understand how dementia caregivers in the township of Soweto, South Africa interpret their role in the context of caregiving through the personal constructs identified using the Self- Characterization technique. Thirty family caregivers were recruited via purposive sampling methods and completed a Self-Characterization Sketch during semi-structured interviews. Content analysis of construct pairs was thematically coded using the Classification System for Personal Constructs (CSPC) - a reliable method to analyse personal constructs that are generated by constructivist assessments. Findings revealed that caregivers' interpretations of themselves was characterized by moral, emotional and cognitive attributes. Specifically, a sense of mastery, self-efficacy, strength, selflessness and unconditional positive regard characterized the most meaningful constructs of care within caregiver narratives in response to their loved ones with dementia. These adaptive outcomes, despite the challenging, pervasive, complex nature of dementia and its manifestations, suggest psychological and emotional resilience, higher levels of adjustment and caregiver well-being. However, it is important to consider possible consequences such as physical fatigue and burnout despite adaptive outcomes. Therefore, it is recommended that approaches to psychoeducational initiatives, emotional and psychological interventions and awareness campaigns include teaching caregivers how to self-care encourage the importance of consistent exercise, rest, sleep, nutrition as well as reaching out for social support. Lastly, empowering caregivers to use their personal resources would prove valuable in support groups, and individual to facilitate self-awareness, sustained coping and mental health.