The characteristics of dementia caregiving onset

The Changing Tides of Caregiving During the COVID-19 Pandemic: How Decreasing and Increasing Care Provision Relates to Caregiver Well-Being

OBJECTIVES

Pandemic-specific changes to the caregiving context (e.g., attempts to reduce exposure, physical distancing requirements) may lead to changes in care provision. This study uses the 2020 National Health and Aging Trends Study Family Members and Friends coronavirus disease 2019 (COVID-19) questionnaire to explore changes in the amount of care provision during COVID-19 and associations with stress process outcomes of caregiving.

METHODS

The sample includes 1,020 caregivers who provided care for an older adult during COVID-19. Caregivers indicated whether their hours of care decreased, stayed stable, or increased during the pandemic. We describe reasons for change in care and compare changes in care by demographic and care-related characteristics using chi-squares and analyses of variance, and relate changes in care with stress process outcomes (e.g., overload, COVID-related anxiety) using multivariable linear regression.

RESULTS

Caregivers were 60.7 years old on average, 69.3% were female, and 18.6% were non-White. While most caregivers reported no change, 30.5% reported an increase and 11.5% reported a decrease in the amount of pandemic care provided. Relative to maintaining stable care provision, an increase was associated broadly with worse mental health and care-related stress, whereas a decrease was associated with greater emotional difficulty related to care and lower levels of positive affectivity.

DISCUSSION

Those who changed their care provision during the pandemic predominantly did so to protect their care recipient from COVID-19 exposure. Increasing one's care provision was strongly associated with worse mental health and well-being. Supports for caregivers who take on additional care tasks during the pandemic could have great public health benefit.

Dementia Caregiving Outcomes: The Impact of Caregiving Onset, Cognitive Impairment and Behavioral Problems

With a projected increase in the prevalence of Alzheimer's disease (AD) and related dementias, family caregiving is steadily increasing. Caring for an individual with AD is characterized as a "career," and within this career are a number of key transitions, including the onset of caregiving. Research reveals a number of negative emotional health outcomes for AD caregivers, including depression and role overload, but less research has examined the influence of key transitions on the emotional adaptation of caregivers. The purpose of this study is to examine how different patterns of caregiving onset (gradual and abrupt) impact emotional health outcomes for AD caregivers. This study also explores how care-recipient cognitive impairment and behavioral problems moderate these relationships. Cross-sectional, quantitative data from 100 caregivers completing self-administered surveys were used. A series of one-way ANOVAs and multiple regression analyses were conducted to address study aims. Results indicate that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and emotional health outcomes for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering different onset transitions and moderating factors within the caregiving career to target clinical interventions. Implications for social work practice are discussed.

Transitioning into the caregiver role following a diagnosis of Alzheimer's disease or related dementia: A scoping review

OBJECTIVES

To identify experiences, needs, interventions and outcomes for caregivers of persons with Alzheimer's disease or related dementia as they transition into this new role following diagnosis.

DESIGN

Scoping review of published literature.

DATA SOURCES

A search for published articles was conducted in PsycINFO, Scopus, Ovid and Web of Science databases.

REVIEW METHODS

The Arksey and O'Malley methodological framework guided the review. Studies were screened independently for inclusion by two persons. A total of 955 studies, after duplicates removed, were found by the database search. From these, 127 full-text articles were retained through the screening of titles and abstracts by two reviewers. The two reviewers assessed 46 full-text articles for eligibility. The final 29 studies identified caregiver experiences, needs, and interventions during the period following a diagnosis of Alzheimer's disease or related dementia in the scoping review.

RESULTS

Twenty-nine studies were organized around three major categories: i) family caregiver experiences on receiving the diagnosis (n = 23), ii) needs during this time of transition (n = 18), and iii) interventions and outcomes to support their transition into the caregiver role (n = 5). While studies may have addressed more than one topic, 16 studies intersected categories of both caregiver experience and needs, and one study intersected categories of needs and interventions. There were several studies that focused more specifically on the caregiver's initial reactions to a diagnosis of Alzheimer's disease or related dementia (n = 9), the emotional responses to the diagnosis (n = 14), changes in personal relationships and responsibilities with a new role (n = 16). Caregiver needs following the diagnosis included knowledge and information (n = 14), emotional and psychological support (n = 11), and assistance with care planning (n = 7). Five papers examined interventions specifically tailored to caregiver needs at this juncture, which support the transition into the caregiver role.

CONCLUSIONS

The time of receiving a diagnosis of Alzheimer's disease or related dementia is a critical period in the process of transitioning into caregiver role. This period marks a new phase in the process of caring by family caregivers. Thus, it is important to fully understand the experiences and needs of caregivers and effective interventions in order to better support their transition into this new role.

Factors Associated with Unmet Needs among African-American Dementia Care Providers

Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5^th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed needs were daytime respite care and especially a desire for family and social support. Many caregivers expressed a need for other family members to share responsibility in the process; therefore, methods for caregiver support that address multiple family members in care provision may be beneficial for this group.

The Effect of Transitions in Caregiving Status and Intensity on Perceived Stress Among 992 Female Caregivers and Noncaregivers

BACKGROUND

Informal caregiving, a chronic stressor, is also a dynamic experience, as caregivers may repeatedly enter and exit the role and alter the amount of care they provide. Changes in caregiving status and intensity influence stress, but few studies have evaluated the simultaneous impact of these changes on perceived stress.

METHODS

A total of 1,027 female caregivers and noncaregivers (mean age = 81.7), of which 992 were included in the final sample, were followed for at least two consecutive annual interviews (ie, one interval) and up to five interviews over a 9-year period. Caregiving status was measured by self-report of whether the respondent assisted someone with at least one basic or instrumental activity of daily living; caregiving intensity was dichotomized at the median number of basic or instrumental activity of daily living tasks caregivers performed. The associations between changes in caregiving status and intensity level with Perceived Stress Scale (PSS) score at the end of an interval were estimated using mixed-effects regression models.

RESULTS

Respondents contributed 2,832 intervals. High-intensity caregivers reported the highest stress at the end of an interval, whereas noncaregivers reported the lowest (mean PSS = 18.97 vs 15.73, p < .01). Low-intensity caregivers, whose intensity increased, had higher stress than continuing high-intensity caregivers. Those who stopped caregiving, regardless of intensity level, reported the same amount of stress as noncaregivers.

CONCLUSIONS

Transitions in caregiving status and intensity affect caregiver perceived stress. Continuing high-intensity caregivers and those who transition from low- to high-intensity caregiving report the highest stress of all transition groups, suggesting that stress-reduction interventions should target high-intensity caregivers.

The transition to dementia--individual and family experiences of receiving a diagnosis: a review

BACKGROUND

Consensus recommends early recognition of memory problems through multi-disciplinary assessment in memory clinics; however, little is known about the experiences of people accessing such services. The aim of this review was to synthesis empirical evidence on patient and carer experiences in the transition to dementia.

METHODS

This review updates an earlier review (Bamford et al., 2004) on the topic of disclosure of the diagnosis of dementia. Key electronic databases were searched including OVID Medline, CINAHL, Web of Science, EMBASE, and Sociological Abstracts; this was supplemented by hand searching of reference lists and contact with experts in the field. Only papers published after 2003 were included.

RESULTS

Of the 35 papers included in the review, only one study observed the process of disclosure and only two papers explored the effects on the person with dementia's health. The vast majority of people with dementia wished to know their diagnosis. The key challenges for the person with dementia were coming to terms with losses on multiple levels. Although there may be short-term distress, the majority of people with dementia do not appear to experience long-term negative effects on their psychological health. For family carers, becoming the main decision-maker and adjusting to increased responsibility were common concerns.

CONCLUSIONS

There is still little empirical research observing the process of diagnostic disclosure in dementia. Studies exploring the views of patients and their families suggest this should be an ongoing process with the provision of support and information tailored to individual needs. The term "Alzheimer's disease" appears to have more negative connotations than the word "dementia".

Social Representations of Barriers to Care Early in the Careers of Caregivers of Persons With Alzheimer's Disease

The first signs of cognitive impairment in the elderly generally elicit much concern among family members. Reactions run from denial to the active search for information. Some families manage to set up relatively well-organized networks of informal support to help both caregivers and elderly relatives. However, little is known about the processes underlying the different pathways that families follow at the onset of Alzheimer-type dementia in elderly relatives. To gain a better understanding of barriers to care early in the caregiving career, from the first signs of illness to diagnosis, the authors conducted interviews with 52 caregivers recruited at two cognition clinics. Barriers to help resources were analyzed from the viewpoint of social representations. This approach allowed the consideration of a broad range of individual and group phenomena capable of fashioning caregivers' representations of this period. The results confirmed the importance of the symbolic dimension of experience in steering social practice.

Reluctance to Care

Primary lay carers are increasingly important in the care of patients with cancer, but their role can be complex and extended. Potential carers may feel anything from highly committed to not at all interested in caregiving, but powerful social norms pressure them to accept the role, and reluctance may be hidden to avoid censure. The purpose of this review was to gain insights into caregiving reluctance and its consequences. The findings were organized into 4 major dimensions: demographic, physical, psychological, and social. Three major outcomes were identified: deterioration in the carer-patient relationship, reduced quality of care, and institutionalization. Definitive answers to the review questions remain elusive. Choice seems to be a major indicator of caregiving reluctance, although reluctance may not remain static over the caregiving trajectory. Caregiving reluctance remains an underexplored topic, particularly in the context of cancer.

The emotional ramifications of unmet need in dementia caregiving

Using a unique measure of unmet need that taps into several dimensions of informal long-term care, the present study included data from 694 informal caregivers of persons suffering from dementia at different times in the caregiving career (e.g., at home, following institutionalization, following the death of the care recipient). Multivariate regression models found that unmet need for either confidante or formal support had key implications for caregivers' emotional distress in each of the care situations. The findings suggest that conceptual models should incorporate unmet need as a viable predictor of caregiving outcomes and that assessment of unmet need may provide guidance in the development of more refined psychosocial and community-based intervention protocols.