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Brito L, Bernardo AC, Leite Â, Pereira MG. Portuguese Caregivers of Persons With Alzheimer's Disease in the Context of the COVID-19 Pandemic: A Qualitative Study of the Grieving Process. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241246417. [PMID: 38697016 DOI: 10.1177/00302228241246417] [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: 05/04/2024]
Abstract
This study addresses the experiences of informal caregivers caring for elderly family members with Alzheimer's disease (AD) during the COVID-19 pandemic. The study includes a sample of eight informal caregivers who were evaluated through a semi-structured interview six months after the death of a loved one they cared for. A thematic content analysis was applied to the interviews and yielded two higher-order domains: (1) Experiencing the AD and the death of a family member and (2) The grieving process during the COVID-19 pandemic. The results provide valuable insights into family caregivers' experiences regarding the profound emotional impact of caregiving and grief during the COVID-19 pandemic. Caregivers maintain their identity even after loss, underscoring the enduring impact of caregiving. The identity as a caregiver impacted coping and grief responses, highlighting the need for tailored interventions.
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Affiliation(s)
- Laura Brito
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Ana Cristina Bernardo
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - Ângela Leite
- Centre for Philosophical and Humanistic Studies, Portuguese Catholic University, Braga, Portugal
| | - M Graça Pereira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
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Ko E, Helsabeck NP, Yang Y, Rose KM. A mediating role of self-care difficulty in the association between caregiver strain and the impact of caregiving on health: A cross-sectional secondary analysis. Geriatr Nurs 2024; 57:179-187. [PMID: 38663186 DOI: 10.1016/j.gerinurse.2024.04.015] [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: 01/07/2024] [Revised: 03/23/2024] [Accepted: 04/12/2024] [Indexed: 06/04/2024]
Abstract
Caregivers of people living with dementia face strain, reduced self-care, and poorer health status. However, research examining the links among those outcomes is limited. We explored the association between caregiver strain and the impact of caregiving on health status and identified the mediating role of self-care difficulty in this association. In the national caregiving dataset "Caregiving in the U.S. 2020," we included 312 caregivers in this study. Demographics, caregiving characteristics, a composite scale for caregiver strain, and single-item questions for the impact of caregiving on health status and self-care difficulty were used. Descriptive statistics and mediation analysis were conducted. Results revealed that higher caregiver strain was associated with higher self-care difficulty (OR 2.054, p < .001) and negative health changes due to caregiving (OR 2.719, p < .001). Self-care difficulty partially mediated this association. These results indicated the need to explore interventions or resources to offer caregivers to encourage their self-care awareness and activities.
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Affiliation(s)
- Eunjung Ko
- College of Nursing, The Ohio State University, Columbus, OH, USA.
| | | | - Yesol Yang
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Karen M Rose
- College of Nursing, The Ohio State University, Columbus, OH, USA
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3
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Morimoto H. Profiles of psychological flexibility and caregiving experience in dementia family caregivers: A latent profile analysis. J Clin Psychol 2024. [PMID: 38639034 DOI: 10.1002/jclp.23696] [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: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To explore the profiles of psychological flexibility among dementia family caregivers and examine their associations with psychological well-being and caregiving factors. METHODS Participants were 521 dementia family caregivers in Japan. Latent profile analysis was conducted to explore the profiles of psychological flexibility. The analyses examined differences in depression, anxiety, life satisfaction, and work-family conflict/enrichment between the profiles, and whether sociodemographic variables and caregiving stressors predict the profile. RESULTS Four distinct profiles were identified: high psychological flexibility (14.2%), moderate psychological flexibility with high commitment (24.7%), moderate psychological flexibility with low commitment (48.0%), and low psychological flexibility (13.1%). The low psychological flexibility profile exhibited the highest scores of depression, anxiety and work-family conflict, followed by the moderate psychological flexibility with low/high commitment profiles, and the high psychological flexibility profile. The high psychological flexibility and moderate psychological flexibility with high commitment profiles exhibited higher life satisfaction than the moderate psychological flexibility with low commitment profile. Caregiving stressors, marital status, and caregiver status predicted the profile. CONCLUSION Enhancing defusion and acceptance, rather than increasing commitment to personal values, may be beneficial in supporting distressed caregivers. Having more caregiving stressors, being single/divorced/bereaved, and being a primary caregiver may be useful indicators of decreased psychological flexibility among dementia family caregivers.
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Camões-Costa V, Taylor B, Barton C, Chakraborty S, Hewitt A, Lin X, Brijnath B. Mental health outcomes of family carers after admission to aged care: A cross-sectional survey study. Australas J Ageing 2024. [PMID: 38597573 DOI: 10.1111/ajag.13314] [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: 03/27/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES This study investigated the predictors of poor mental health outcomes among family carers of residents after transitioning into residential aged care. METHODS Using a cross-sectional design, five groups of variables were evaluated as predictors: caregiver demographics; caregiving load; resident-related variables; loneliness and visiting frequency; and the impact of the COVID-19 context. A total of 309 primary family contacts of all residents of two residential aged care organisations in the state of Victoria (Australia) participated in the study (response rate 19%). The K-10 and the Burden Scale for Family Caregivers were used to measure the primary outcomes. We compared psychological distress and burden outcomes between carers whose relative was admitted within the last 12 months, or longer than 12 months ago. RESULTS Time since admission (<12 months or >12 months) did not affect the level of psychological distress (t (238) = -.08, p = .94) or subjective burden (t (245) = -.89, p = .38). Being a woman, a spouse, speaking a language other than English at home, being less satisfied with the support offered by the facility, not feeling supported in the decision to admit their relative, being lonely and providing higher levels of care preadmission were predictors of poor mental health outcomes. CONCLUSIONS Older women with low-English proficiency who were primary carers and are socially isolated, are more likely to experience poor mental health outcomes and need additional support. These findings may inform the development of screening tools and tailored interventions to support this population during and after the transition process.
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Affiliation(s)
- Vera Camões-Costa
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Taylor
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Samantha Chakraborty
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alana Hewitt
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bianca Brijnath
- National Ageing Research Institute Ltd, Melbourne, Victoria, Australia
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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Han A, Malone LA, Lee HY, Gong J, Henry R, Zhu X, Yuen HK. The use of ecological momentary assessment for family caregivers of adults with chronic conditions: A systematic review. Health Psychol Res 2024; 12:93907. [PMID: 38435338 PMCID: PMC10908591 DOI: 10.52965/001c.93907] [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: 12/25/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Background Ecological momentary assessment (EMA) as a real-time data collection method can provide insight into the daily experiences of family caregivers. Purpose This systematic review aimed to synthesize studies involving EMA completed by family caregivers of adults with chronic conditions. Methods A systematic search was conducted within six databases for articles published from the inception of the database through September 2023. We extracted the characteristics of the included studies and data on EMA-specific methods to determine the quality of the included studies. Results A total of 12 studies involving EMA completed by family caregivers of adults with chronic conditions were identified, with almost all studies focused on caregivers of persons with Alzheimer's or dementia-related conditions. The average compliance rate across the included studies was 75%, below the recommended rate. In addition, most of the included studies did not collect the family caregivers' daily activities and care contexts in their responses (i.e., affect, stress, well-being, care demand, and fatigue) to the EMA prompts. Discussion This review showed that using EMA to collect information on family caregivers of adults with chronic health conditions appeared feasible and acceptable. However, the methodology or design of using EMA to collect caregiver information in this population is still preliminary. The limited number of existing studies that have used EMA to capture the daily experiences of family caregivers does not provide key information that could improve understanding of caregivers' emotional experiences and well-being in real-life situations. We identified gaps in the literature that warrant additional EMA studies for this population.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham
| | - Laurie A Malone
- Department of Occupational Therapy, University of Alabama at Birmingham
| | | | - Jiaqi Gong
- Department of Computer Science University of Alabama
| | - Ryan Henry
- Department of Computer Science University of Alabama
| | - Xishi Zhu
- Department of Computer Science University of Alabama
| | - Hon K Yuen
- Department of Occupational Therapy, University of Alabama at Birmingham
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Monteiro I, Brito L, Pereira MG. Burden and quality of life of family caregivers of Alzheimer's disease patients: the role of forgiveness as a coping strategy. Aging Ment Health 2024:1-8. [PMID: 38425032 DOI: 10.1080/13607863.2024.2320138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This study aimed to evaluate the variables that were associated, contributed and moderated quality of life (QoL) and burden in family caregivers. METHODS A total of 130 participants were evaluated using the following instruments: Depression, Anxiety and Distress Scale; Index of Family Relations; Heartland Forgiveness Scale; Burden Interview Scale; Short Form Health Survey. RESULTS Being a younger caregiver, less distress, better family relationships and greater use of forgiveness were associated with more QoL. Also, family caregivers who chosethe caregiving role, less distress, better family relationships and greater use of forgiveness showed lower levels of burden. Age, distress and forgiveness contributed to QoL. In turn, the choice to become a family caregiver, distress, and forgiveness contributed to burden. Forgiveness played a moderating role in the relationship between family relationships and burden. CONCLUSION Based on the results, there is a need to intervene in older family caregivers, particularly those who did not choose to become a caregiver, who report greater distress, have worse family relationships, and display less use of forgiveness, in order to decrease their burden and promote QoL.
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Affiliation(s)
- Isabela Monteiro
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Laura Brito
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - M Graça Pereira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, Jones RW, Allan L, Knapp M, Quinn C, Victor C, Pentecost C, Rusted JM, Morris RG, Clare L. Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme. BMC Geriatr 2024; 24:171. [PMID: 38373905 PMCID: PMC10875834 DOI: 10.1186/s12877-024-04707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers' outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers' stress, positive experiences of caregiving, and social networks METHODS: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used RESULTS: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers' health conditions increased, their stress increased whereas their social network diminished DISCUSSION: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks.
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Affiliation(s)
- Serena Sabatini
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, UK.
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK.
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Roy W Jones
- Research Institute for the Care of Older People (RICE), Bath, UK
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Christina Victor
- College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, London, UK
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Robin G Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, UK
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Martis CS, Bhandary RP, Chandrababu R, Lakshmi R V, Bhandary PV, Noronha JA, Chakrabarty J, Tolson D, Devi ES. Caring burden and quality of life among the caregivers of people living with dementia - a cross-sectional study in Udupi district of Karnataka. Home Health Care Serv Q 2024:1-14. [PMID: 38190733 DOI: 10.1080/01621424.2023.2301417] [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: 01/10/2024]
Abstract
Dementia is a chronic disorder of the brain that affects cognitive performance. The caregivers of individuals with dementia experience a greater burden that affects their Quality of Life (QoL). This cross-sectional study conducted in India was designed to assess the caring burden and QoL among the caregivers of people with dementia, as well as to ascertain the relationship between QoL scores and burden. Our sample included 80 caregivers of people with dementia. Most of the caregivers (n = 59, 73.8%) had a higher level of caregiver burden. There was a negative correlation between caregiver burden scores and QoL. A higher level of caregiver stress and low QoL were experienced by caregivers of dementia patients. In developing countries like India, counseling, and education on home health care for people with dementia should be provided to reduce the burden and enhance the QoL of caregivers.
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Affiliation(s)
- Clarita Shynal Martis
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | | | - Ramesh Chandrababu
- Department of Medical Surgical Nursing, Sri Ramachandra Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Vani Lakshmi R
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Judith Angelitta Noronha
- Department of Obstetrics and gynaecological nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Chakrabarty
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Debbie Tolson
- Alzheimer Scotland Centre for Policy and Practice, University of West of Scotland, Scotland, UK
| | - Elsa Sanatombi Devi
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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Dunn R, Wolverson E, Hilton A. Exploring the interplay between dementia, multiple health conditions and couplehood: A qualitative evidence review and meta-ethnography. DEMENTIA 2024; 23:41-68. [PMID: 37969077 DOI: 10.1177/14713012231214017] [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: 11/17/2023]
Abstract
Background: On average, people with dementia live with 4.6 additional health conditions. Additionally, two thirds of carers of people with dementia are spouses, and are also likely to live with multimorbidity, given that older age is strongly associated with an increase in health conditions. Consequently, living with dementia and multimorbidity is often a shared experienced as a couple. However, research has not explored how living with both dementia and multimorbidity may impact on couplehood. Method: We conducted a qualitive evidence review using a meta-ethnographic approach, to answer the following question: In what way (if any) does living with dementia and multimorbidity impact on couplehood? No papers were found on couplehood, dementia and multimorbidity, therefore the review consists of a meta-synthesis of couples' experiences of living with dementia in relation to couplehood, with an additional search for any data related to health within the qualitative findings. Findings: Two major reciprocal themes and five subthemes were identified from the 14 study findings. 1. Change and adjustment in the relationship, which included themes around a sense of 'togetherness', change in roles and identity and developing shared coping strategies and 2. Commitment, which was encapsulated by themes on unconditional love and commitment to wedding vows. Health-related findings were limited but included the impact on emotional wellbeing and how other health conditions, rather than dementia, were attributed to a loss in physical sexual intimacy. Conclusion: This review found that couplehood was threatened when dementia symptoms progressed and couples experienced feelings of loss of independence and identity. However, a strong foundation of commitment, love and loyalty to each other developed over the course of the relationship, was the 'glue' that helped couples face dementia together. However, further research is needed to explore couples' experiences of living with both multimorbidity and dementia in relation to couplehood in order to develop holistic, relationship-centred interventions.
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Affiliation(s)
- Rosie Dunn
- School of Psychology and Social Work, Faculty of Health Sciences, University of Hull, UK
| | - Emma Wolverson
- School of Psychology and Social Work, Faculty of Health Sciences, University of Hull, UK
| | - Andrea Hilton
- School of Paramedical, PeriOperative and Advanced Practice, Faculty of Health Sciences, University of Hull, UK
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BeLue R, Kuzmik A, Dix M, Luckett C, Paudel A, Resnick B, Boltz M. An exploration of the cultural appropriateness of the family-centered function-focused care intervention. DEMENTIA 2024; 23:7-22. [PMID: 37902027 DOI: 10.1177/14713012231206288] [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: 10/31/2023]
Abstract
The Family-centered Function Focused Care (Fam-FFC) intervention, is a nurse-family care partnership model aimed to improve the physical and cognitive recovery in hospitalized persons living with Alzheimer's Disease Related Dementias (ADRD) while improving the care partner's experiences. Discussions of patients' needs and preferences between nurses and the patient's close family members have been found to be useful in preventing excessive stress in persons with dementia, while lessening the anxiety of care partners. However, the efficacy of dementia-specific interventions is influenced in part by the degree to which the interventions are flexible and sensitive to the patient's and care-partner's condition, needs, and preferences, including cultural preferences. Therefore, the purpose of this study is to assess the cultural appropriateness of Fam-FFC using the Ecological Validity Model (EVM). This qualitative, descriptive study included 28 consented care partners drawn from a sample of 455 dyads enrolled in the Fam-FFC intervention. An interview guide was created based on the EVM. Participants provided demographic data. Thematic analysis was conducted to analyze transcribed interviews. The majority of the sample was female (79%), Non-Hispanic (96%) and half were married. One-half of the sample represented Black care partners and one-half were White. Seventy-nine percent lived with their family member with ADRD. Three major themes were identified from the thematic analysis including Care Partner Identity, Care Partner Preferences, and Goals of Care for functional recovery of their family member living with dementia. In this study care partners wanted more social services as well as home care that supported not just physical needs but also social and recreational needs. Findings from the study offer guidance on improving the Fam-FFC intervention including strengthening education and resources on partner self-care.
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Affiliation(s)
- Rhonda BeLue
- College for Health, Community and Policy, Community Engagement and Partnerships, The University of Texas at San Antonio, USA
| | - Ashley Kuzmik
- Ross and Carol Nese College of Nursing, Penn State, USA
| | - Michaila Dix
- College of Public Health and Social Justice, Department of Health Management and Policy, Saint Louis University, USA
| | - Camille Luckett
- College for Public Health and Social Justice, Saint Louis University, USA
- University of Maryland School of Nursing, USA
| | - Anju Paudel
- Ross and Carol Nese College of Nursing, Penn State, USA
| | | | - Marie Boltz
- Ross and Carol Nese College of Nursing, Penn State, USA
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Nesser W, Snyder S, Driscoll KA, Modi AC. Factors associated with quality of life for cystic fibrosis family caregivers. DISCOVER MENTAL HEALTH 2023; 3:20. [PMID: 37982907 PMCID: PMC10579194 DOI: 10.1007/s44192-023-00046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 11/21/2023]
Abstract
Cystic Fibrosis (CF) is a genetic and chronic disease affecting 32,100 people in the United States as of 2021, with a life expectancy of 56 years for people with CF (PwCF) born between 2018 and 2022. While there is extensive literature about cystic fibrosis, there are few studies examining the complexity and challenges experienced by family caregivers for PwCF. The aim of this study was to examine the Caregiver Quality of Life Cystic Fibrosis (CQOLCF) scale using data (N = 217) from two separate studies that used the scale to determine if its items represent multiple factors relevant to CF family caregiver QoL. Factor analysis was conducted on the Seven distinct factors were found with analysis of the CQOLCF. Factors were Existential Dread (12%), Burden (11%), Strain (7%), Support (7%), Positivity (6%), Finance (5%) and Guilt (3%). Study findings indicated it is important for healthcare providers and researchers who use the CQOLCF to be knowledgeable and aware of the multiple factors associated with quality of life in this population in addition to an overall quality of life score.
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Affiliation(s)
- Whitney Nesser
- Department of Applied Clinical and Educational Sciences, Indiana State University, 401 N. 7th Street, Room 302B, Terre Haute, IN, 47809, USA.
| | - Scott Snyder
- School of Education, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Avani C Modi
- Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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12
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Baik JS, Min JH, Ko SH, Yun MS, Lee B, Kang NY, Kim B, Lee H, Shin YI. Effects of Home-Based Computerized Cognitive Training in Community-Dwelling Adults With Mild Cognitive Impairment. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:97-105. [PMID: 38088994 PMCID: PMC10712670 DOI: 10.1109/jtehm.2023.3317189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE There is a growing importance for the home-based (HB) support services, and computerized cognitive training (CCT) has been reported as an effective intervention for cognitive impairment. However, there is still a need for further verification of the effect of HB-CCT. This study aimed to determine the effectiveness of HB-CCT on the cognitive function of community-dwelling adults with mild cognitive impairment (MCI) as well as safety in its use. METHODS Fifty community-dwelling adults with MCI were included, of which 25 each were randomized to either HB-CCT or control groups. Evaluations of comprehensive cognition, memory, attention, language, executive function, and depression were performed before and after the intervention, including three times a week for eight weeks in the intervention group and eight weeks apart with no intervention in the control group. RESULTS In baseline and post-evaluation comparisons, the HB-CCT group showed significant improvements, while the control group did not show significant changes. Statistically significant variations were noted between the HB-CCT and control groups in all post-intervention evaluations relative to baseline. Additionally, no side effects were observed. CONCLUSION Beneficial effects on cognition and depression were noted in the intervention group compared with the control group, suggesting that HB-CCT may be a positive tool for cognitive improvement in adults with MCI.
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Affiliation(s)
- Ji Soo Baik
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
- Department of Rehabilitation MedicineThe Graduate School of MedicinePusan National UniversityYangsan50612Republic of Korea
| | - Mi Sook Yun
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Byunghoon Lee
- Department of Rehabilitation MedicinePusan National University HospitalBusan46241Republic of Korea
| | - Nae Yoon Kang
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
| | | | | | - Yong-Il Shin
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
- Department of Rehabilitation MedicineThe Graduate School of MedicinePusan National UniversityYangsan50612Republic of Korea
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Yu Y, Xiao L, Ullah S, Meyer C, Wang J, Pot AM, He JJ. The effectiveness of internet-based psychoeducation programs for caregivers of people living with dementia: a systematic review and meta-analysis. Aging Ment Health 2023; 27:1895-1911. [PMID: 36951611 DOI: 10.1080/13607863.2023.2190082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The objectives of this systematic review and meta-analysis were to identify the characteristics of internet-based psychoeducational programs for caregivers of people living with dementia and to synthesise program effectiveness. METHOD Five English databases and four Chinese databases were searched in June 2021 with no time limit applied. A narrative summary was performed to describe the characteristics of studies reviewed. Meta-analysis was applied to synthesise the pooled effects where data were available. RESULTS A total of 14352 articles were identified from the database search and 19 were included in the final review. Interventions comprised educational, psychological, and behavioural training relevant to dementia care. Program duration ranged from 3 weeks to 12 months. Meta-analysis of 13 RCTs showed that internet-based psychoeducational programs had a significant effect on reducing caregivers' depressive symptoms (SMD -0.19; 95% CI -0.03 - 0.35) and stress (SMD -0.29; 95% CI -0.03 -0.54). However, these programs did not show an effect on quality of life, anxiety, burden or self-efficacy in caregivers. CONCLUSION Internet-based psychoeducational programs can improve some aspects of caregivers' mental health and emotional wellbeing. The effects of programs on self-efficacy, anxiety, burden and quality of life for caregivers remain inconclusive.
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Affiliation(s)
- Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Melbourne, Victoria, Australia
| | - Jing Wang
- Faculty of Nursing, Xi'an Jiao tong University, Xi'an, China
| | - Ann Margriet Pot
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
- Optentia, North-West University, Vanderbijlpark, South-Africa
| | - Jin Jie He
- Faculty of Nursing, Xi'an Jiao tong University, Xi'an, China
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14
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Contreras M, Khondoker M, Mioshi E, Kishita N. Factors affecting the quality of life of family carers of people with dementia: the role of carer anxiety. PSYCHOL HEALTH MED 2023; 28:843-853. [PMID: 35769020 DOI: 10.1080/13548506.2022.2093926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The role of anxiety on the quality of life of family carers of people with dementia is somewhat neglected in the carer literature. The current study aimed to investigate the impact of common risk factors (i.e., care recipient's neuropsychiatric symptoms, carer depression, and burden) and anxiety on QoL. This cross-sectional study recruited 89 family carers. Most of the participants were looking after a spouse with Alzheimer's or mixed dementia. A multiple regression analysis was conducted with carer QoL as a dependent variable. All risk factors (i.e., people with dementia's neuropsychiatric symptoms, carer depression, anxiety, and burden) were entered into the model simultaneously as independent variables. The model's R2 was 33%. The results demonstrated that anxiety was the only significant independent variable predicting carer QoL (β = - 0.34, p = 0.03, 95% CI: - 0.64 to - 0.04). These results indicated that having more symptoms of anxiety was associated with worse QoL as measured by the ICEpop CAPability measure for Older people (ICECAP-O). These findings suggested that improving carer's anxiety may be particularly important in promoting QoL among family carers of people with dementia. Future interventions should target this variable to achieve the desired result of improving carer QoL.
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Affiliation(s)
- Milena Contreras
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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15
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Nesser W, Grace Yi EH, Wotring AJ, Hutchins MD, Snyder S. A Partial Picture, Without a Frame: Measuring Quality of Life in Cystic Fibrosis Caregivers. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2023.2186984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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16
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Ellis KR, Koumoutzis A, Lewis JP, Lin Z, Zhou Y, Chopik WJ, Gonzalez R. Conceptualizing and Operationalizing Collaboration Among Multiple Caregivers of Older Adults. J Gerontol B Psychol Sci Soc Sci 2023; 78:S27-S37. [PMID: 36409283 PMCID: PMC10010467 DOI: 10.1093/geronb/gbac139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In many families, multiple caregivers support older adults living with dementia. Studying collaboration among caregivers requires consideration of conceptual and methodological issues that have not been fully explored. This study presents a framework for conceptualizing caregiver collaboration and an index that captures variation in collaboration among multiple caregivers within care networks. METHODS We used data from the 2015 waves of the National Health and Aging Trends Study and National Study of Caregiving (NSOC) to operationalize collaboration among multiple caregivers (N = 1,298) of 552 care recipients (Mage = 83.69, SD = 7.73; 71.6% women; 47.9% possible/probable dementia; 38.9% people of color). RESULTS The care collaboration index considered individual and overlapping contributions while controlling for the size of the care network (caregivers in network responding to NSOC survey) and total network size (number of caregivers in network) in the statistical model. Larger care networks enabled more collaboration, both in general and across most types of tasks (βs > 0.38). Collaboration was greater among those caring for a Black or Hispanic care recipient, both in general and for household and medical/health tasks specifically (βs > 0.11). Collaboration was also greater among those caring for recipients with probable dementia, both in general and for most tasks (βs > 0.11) but not transportation-related tasks (p = .219). DISCUSSION Results are examined in the context of care network dynamics and proposed mechanisms linking care collaboration to outcomes for caregivers and recipients. Strengths and limitations of our conceptualization and operationalization of collaboration are discussed.
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Affiliation(s)
- Katrina R Ellis
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Athena Koumoutzis
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
| | - Jordan P Lewis
- University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota, USA
| | - Zhiyong Lin
- Department of Sociology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Yuanjin Zhou
- Steve Hicks School of Social Work, the University of Texas at Austin, Austin, Texas, USA
| | - William J Chopik
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Richard Gonzalez
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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17
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Han A, Yuen HK, Jenkins J. The feasibility and preliminary effects of a pilot randomized controlled trial: Videoconferencing acceptance and commitment therapy in distressed family caregivers of people with dementia. J Health Psychol 2023; 28:554-567. [PMID: 36591636 PMCID: PMC10119897 DOI: 10.1177/13591053221141131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This pilot randomized controlled trial (RCT) examined preliminary effects of an 8-week videoconferencing acceptance and commitment therapy (ACT) program supplemented with psychoeducation materials on distressed family caregivers of persons living with dementia (PLWD) compared to the control group provided with psychoeducation materials only. Nineteen family caregivers of PLWD in the USA were randomly assigned to the ACT group or the control group. Data was collected at pretest, posttest, and 1-month follow-up (F/U). Compared to the control group, the ACT group showed a significantly larger reduction in grief at posttest, with a medium effect size. Small effects of ACT were found in anxiety, psychological quality of life, and engagement in meaningful activities at posttest and grief, engagement in meaningful activities, and psychological flexibility at F/U compared to the control group. These promising findings warrant a full-scale RCT with adequate power to measure the efficacy of videoconferencing ACT for caregivers of PLWD.
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Affiliation(s)
- Areum Han
- University of Alabama at Birmingham, USA
| | - Hon K Yuen
- University of Alabama at Birmingham, USA
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18
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Liu C, Marino VR, Howard VJ, Haley WE, Roth DL. Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress. Aging Ment Health 2023; 27:87-93. [PMID: 34749554 PMCID: PMC9126189 DOI: 10.1080/13607863.2021.2000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/17/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress. METHODS Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain. RESULTS Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain. DISCUSSION Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Victoria R Marino
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
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19
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Falzarano F, Cimarolli VR, Minahan J, Horowitz A. Long-Distance Caregivers: What are Their Experiences with Formal Care Providers? Clin Gerontol 2022; 45:1273-1284. [PMID: 32589110 PMCID: PMC7762738 DOI: 10.1080/07317115.2020.1783043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Extensive literature has documented the experiences of informal caregivers and their interactions with formal care providers, yet this research is almost entirely limited to caregivers who live near their care-recipients. This study aims to describe long-distance caregivers' (LDC) experiences (e.g., satisfaction and challenges) with formal care providers. Subgroup differences were examined based on the care-recipient's (CR) dementia status and residential setting (community versus residential care). METHODS Data were collected from 296 LDCs (Mage = 56.64, SD = 12.40) categorized into four subgroups based on CR dementia status and residential setting. Participants rated their overall satisfaction, satisfaction with communication and information, and described challenges faced in their interactions with formal care providers. RESULTS Challenges related to formal care providers were significantly greater and satisfaction significantly lower among LDCs of CRs in residential care, irrespective of dementia status, when compared to LDCs of CRs in the community. CONCLUSIONS This study provides insights into the experiences of a growing segment of the caregiver population managing care from a distance, specifically in their interactions with formal care providers. CLINICAL IMPLICATIONS The results of this study point to the possible necessity for the development of novel interventions to improve and enhance communication and collaboration between FCPs and informal caregivers.
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Affiliation(s)
- Francesca Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Verena R Cimarolli
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia, USA
| | - Jillian Minahan
- Psychology Department, Fordham University, Bronx, New York, USA
| | - Amy Horowitz
- Graduate School of Social Services, Fordham University, New York, New York, USA
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20
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Putri YSE, Putra IGNE, Falahaini A, Wardani IY. Factors Associated with Caregiver Burden in Caregivers of Older Patients with Dementia in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12437. [PMID: 36231732 PMCID: PMC9566301 DOI: 10.3390/ijerph191912437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This cross-sectional study aimed to identify caregiver burden and its determinants in the informal caregivers of older patients with dementia (PWDs) aged ≥ 60 years in Java, Indonesia. Data were collected from 207 caregivers of older PWDs using self-administered questionnaires. The dependent variable was caregiver subjective burden, assessed using the Zarit Burden Interview (ZBI). The independent variables included the socio-demographic characteristics of PWDs and caregivers, the caregiver's perceived social support, and the behavioural and psychological symptoms of dementia (BPSD). Linear regression with a stepwise elimination method was used to identify the factors associated with caregiver burden. This study found that four factors were associated with the caregiver burden, such as the gender of PWDs, the educational level of caregivers, social support, and BPSD (R-squared = 27.78%). Higher burden was reported among the caregivers of female PWDs (β = 5.58; 95%CI = 2.16; 8.99) and PWDs with higher scores of BPSD (β = 0.34; 95%CI = 0.25; 0.43). Meanwhile, the caregivers with higher perceived social support (β = -0.26; 95%CI = -0.42; -0.10) and who completed high school education and above (β = -6.41; 95%CI = -10.07; -2.74) tended to have lower scores of subjective burden. These findings suggest that BPSD management and maintaining the resources of support may provide an opportunity to minimise caregiver burden and improve the quality of life of caregivers and PWDs.
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Affiliation(s)
- Yossie Susanti Eka Putri
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia
| | | | | | - Ice Yulia Wardani
- Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok 16424, Indonesia
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21
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Manderson L, Brear M, Rusere F, Farrell M, Gómez-Olivé FX, Berkman L, Kahn K, Harling G. Protocol: the complexity of informal caregiving for Alzheimer's disease and related dementias in rural South Africa. Wellcome Open Res 2022; 7:220. [PMID: 37538406 PMCID: PMC10394391 DOI: 10.12688/wellcomeopenres.18078.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND With aging, many people develop Alzheimer's disease or related dementias (ADRD) as well as chronic physical health problems. The consequent care needs can be complicated, with heavy demands on families, households and communities, especially in resource-constrained settings with limited formal care services. However, research on ADRD caregiving is largely limited to primary caregivers and high-income countries. Our objectives are to analyse in a rural setting in South Africa: (1) how extended households provide care to people with ADRD; and (2) how the health and wellbeing of all caregivers are affected by care roles. METHODS The study will take place at the Agincourt health and socio-demographic surveillance system site of the MRC/Wits Rural Public Health and Health Transitions Research Unit in Mpumalanga Province, northeast South Africa. We will recruit 100 index individuals predicted to currently have ADRD or cognitive impairment using data from a recent dementia survey. Quantitative surveys will be conducted with each index person's nominated primary caregiver, all other household members aged over 12, and caregiving non-resident kin and non-kin to determine how care and health are patterned across household networks. Qualitative data will be generated through participant observation and in-depth interviews with caregivers, select community health workers and key informants. Combining epidemiological, demographic and anthropological methods, we will build a rich picture of households of people with ADRD, focused on caregiving demands and capacity, and of caregiving's effects on health. DISCUSSION Our goal is to identify ways to mitigate the negative impacts of long-term informal caregiving for ADRD when formal supports are largely absent. We expect our findings to inform the development of locally relevant and community-oriented interventions to improve the health of caregivers and recipients, with implications for other resource-constrained settings in both higher- and lower-income countries.
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Affiliation(s)
- Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Social Sciences, Monash University, Clayton, Australia
| | - Michelle Brear
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Social Sciences, Monash University, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Farirai Rusere
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Meagan Farrell
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Berkman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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22
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Dietzel N, Graessel E, Kürten L, Meuer S, Klaas-Ickler D, Hladik M, Chmelirsch C, Kolominsky-Rabas PL. The Dementia Assessment of Service Needs (DEMAND): Development and Validation of a Standardized Needs Assessment Instrument. J Alzheimers Dis 2022; 89:1051-1061. [PMID: 35964189 PMCID: PMC9535555 DOI: 10.3233/jad-220363] [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] [Indexed: 11/23/2022]
Abstract
Background: Dementia is one of the main triggers for care dependency among older adults who are predominantly cared for at home by relatives. To provide support in the care situation, health systems need valid information about the central needs of the affected people. Objective: The present study aimed to develop a research instrument to assess the most important needs of people with dementia and their family caregivers. Methods: The development of the ‘Dementia Assessment of Service Needs (DEMAND)’ took place within the project ‘Digital Dementia Registry Bavaria (digiDEM Bayern)’. A focus group and an online survey with dementia experts were conducted to identify the most relevant support services and to develop the design of the instrument. The questionnaire was deployed in the digiDEM baseline data collection. Participants were asked to evaluate the comprehensibility of the questionnaire. Readability was assessed using the Flesch reading ease score. Results: Seventeen experts participated in the focus group and 59 people in the online survey. The final questionnaire included 13 support services. One hundred eighty-three participants (50 people with dementia and 133 family caregivers) completed the questionnaire at baseline. The mean comprehensibility score was 3.6 (SD = 2.3). The Flesch reading ease score result was 76. Conclusion: A research instrument could be developed, enabling people with dementia and family caregivers to directly express their individual needs for specific support services. Results show that the DEMAND is easy to understand and short in execution. Therefore, supply gaps can be identified and transformed into a specific health care plan.
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Affiliation(s)
- Nikolas Dietzel
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Elmar Graessel
- University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Center for Health Services Research in Medicine, Department of Psychiatryand Psychotherapy, Erlangen, Germany
| | - Lara Kürten
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Sebastian Meuer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Dorothee Klaas-Ickler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Markus Hladik
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Christina Chmelirsch
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Interdisciplinary Center for HealthTechnology Assessment (HTA) and Public Health (IZPH), Erlangen, Germany
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23
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Hoshino J, Tamakoshi K, Hori Y, Sakakibara H. Relationships Between Care Recipients’ Psychological Symptoms and Family Caregivers’ Depressive States. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211058814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This cross-sectional study aims to clarify the relationship between the number of behavioral and psychological symptoms in long-term care recipients and family caregivers’ depressive states. Participants were 38 family caregivers who had provided care for their relatives for 6 years or more; they were recruited from in-home care settings in Aichi, Gifu, and Shiga Prefectures, Japan. Participants answered a self-administered questionnaire assessing their depressive state using the Japanese version of the Center for Epidemiologic Studies for Depression Scale (CES-D). They also answered questions inquiring about behavioral and psychological symptoms of care recipients, including resistance to care, irritability, and feelings of persecution. Using CES-D scores, 11 participants were categorized as depressed and 27 as non-depressed. Depressive symptoms were significantly greater in those with more behavioral and psychological symptoms, following adjustment for confounding factors. The odds ratio of being in a depressive state was 9.43 higher for those with more than 4 behavioral and psychological symptoms compared to those with none, showing a distinct threshold for the influence of behavioral and psychological symptoms on depressive state. Knowing the number of behavioral and psychological symptoms of care recipients may help quickly identify depressed caregivers and alleviate depressive symptoms.
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Affiliation(s)
- Junko Hoshino
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoko Hori
- Happy-Net Association, Nagoya, Aichi, Japan
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24
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Wang AH, Newman K, Martin LS, Lapum J. Beyond instrumental support: Mobile application use by family caregivers of persons living with dementia. DEMENTIA 2022; 21:1488-1510. [PMID: 35414298 PMCID: PMC9237854 DOI: 10.1177/14713012211073440] [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] [Indexed: 12/02/2022]
Abstract
In recent years, there has been a rapid increase in technology use in dementia caregiving, particularly the use of mobile applications (apps) which are highly accessible, cost-effective and intuitive. Yet, little is known about the experiences of family caregivers of persons living with dementia who use apps to support caregiving activities. This is of particular concern given that limited understandings of the user experience in designing technology have often led to end-users experiencing barriers in technology adoption and use. Using a qualitative descriptive approach, the purpose of the study was to explore the experiences of family caregivers of persons living with dementia on using apps in their caregiving roles. A purposive sample of five family caregivers in Ontario, Canada participated in two interviews each, with the second interview informed by photo-elicitation methods. Thematic analysis of the collected data revealed a central overarching theme, Connecting to support through apps in my, your and our lives, which explicated how apps played an important role in the lives of the caregiver, the care recipient and both together as a dyad. Three core themes also emerged: Adapting apps to meet individual needs of the dyad, Minimising the impact of the condition on the person and the family and Determining the effectiveness of apps. The findings highlighted that the value of apps extends beyond their mere functionality and their ability to help with care provision as they are also able to promote richer interpersonal connections, enhance personhood and sustain family routines. This research advances our understanding of the impact of app use in caregiving and provides direction for future research, policy, education, practice and app development.
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Affiliation(s)
- Angel H Wang
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Ontario M5B 2K3, Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Ontario M5B 2K3, Canada
| | - Lori Schindel Martin
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Ontario M5B 2K3, Canada
| | - Jennifer Lapum
- Daphne Cockwell School of Nursing, 7984Ryerson University, Toronto, Ontario M5B 2K3, Canada
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25
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McManus K, Tao H, Jennelle PJ, Wheeler JC, Anderson GA. The effect of a performing arts intervention on caregivers of people with mild to moderately severe dementia. Aging Ment Health 2022; 26:735-744. [PMID: 33769137 DOI: 10.1080/13607863.2021.1891200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to determine the feasibility and acceptability of a multi-modal performing arts intervention (MPAI) for caregivers of people with mild to moderately severe dementia. The secondary objective was to examine how MPAI might change caregiver burden, caregiver resiliency, and perceived quality of life (QoL) for care recipients. METHOD The study features a mixed-methods design. Caregivers (N = 32) completed the Zarit Burden Interview (caregiver burden) Brief Resilience Scale (resiliency) and Quality of Life-Alzheimer's disease measure (care recipient QoL) at five study timepoints. Semi-structured interviews (N = 15) documented the intervention's acceptability and caregivers' subjective experiences. Feasibility was indexed through withdrawal and attendance analysis. Braun and Clarke (2006) thematic analysis guided the qualitative analysis. RESULTS Caregiver burden significantly declined from baseline through final follow-up. Caregiver resiliency and care recipient QoL were not significantly changed but trended up during the intervention until it dropped at the end of the program. Qualitative data suggests the reversal in resiliency and QoL may be explained by caregivers' increased anxiety as the program ended. Acceptability data indicated caregivers were unanimously highly satisfied with the intervention, desiring to continue participation. Feasibility findings provide recommendations for intervention improvements. CONCLUSION MPAI could reduce caregiver burden and increase resilience for informal caregivers of a person with dementia. Effects drop off quickly at the end of the program, indicating the need for ongoing interventions that provide social support, a respite from the pressures of care recipients' dependency, and the relief that caregivers experience when they perceive benefits to their care recipient's well-being.
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Affiliation(s)
- Kim McManus
- AdventHealth Research Institute, Orlando, FL, USA
| | - Hong Tao
- AdventHealth Research Institute, Orlando, FL, USA
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Lee Y, Choi W, Park MS. Respite Service Use Among Dementia and Nondementia Caregivers: Findings From the National Caregiving in the U.S. 2015 Survey. J Appl Gerontol 2022; 41:1557-1567. [PMID: 35303780 DOI: 10.1177/07334648221075620] [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] [Indexed: 11/15/2022] Open
Abstract
This study examined factors related to respite service use among caregivers and further tested the moderating effect of dementia caregiver status in these relationships using nationally representative U.S. data. Logistic regression analyses were conducted among 1203 caregivers (276 dementia and 927 nondementia caregivers). Caregivers' race and ethnicity as a predisposing factor, caregivers' self-rated health as an enabling factor, and care recipients' living arrangement and functional limitations as need factors were significantly related to respite service use. Moreover, dementia caregiver status moderated the association between enabling factors (i.e., household income, work status, and self-rated health) and respite service use. Our findings imply that dementia caregivers may be more in need of respite service use than nondementia caregivers when they have limited enabling factors (e.g., lower household income, nonworking status, poorer health). Policy and practice efforts that specifically support enabling factors are suggested to promote more respite service use among dementia caregivers.
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Affiliation(s)
- Yura Lee
- Department of Social Work, Helen Bader School of Social Welfare, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Wonchan Choi
- School of Information Studies, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Min Sook Park
- School of Information Studies, 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Berwig M, Lessing S, Deck R. Telephone-based aftercare groups for family carers of people with dementia - results of the effect evaluation of a randomised controlled trial. BMC Health Serv Res 2022; 22:177. [PMID: 35144607 PMCID: PMC8831098 DOI: 10.1186/s12913-022-07490-9] [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: 06/19/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The care of people with dementia is associated with enormous stress and, in a quarter of cases, leads to depression and anxiety disorders in the caring relatives. A specially designed inpatient psychosomatic rehabilitation (rehab) programme for family carers of people with dementia has proven to be effective but not sustainable. Therefore, the present study aims to increase the sustainability of the inpatient rehab programme by using thematically structured telephone aftercare group sessions. METHODS The effectiveness of telephone aftercare groups was investigated in a randomized, controlled, prospective, mixed methods, longitudinal study. The aftercare intervention included social participation in monthly telephone group sessions for 6 months. The primary outcome was increased social participation of family carers, which, like the secondary outcomes (such as quality of life and subjective health), was assessed in written surveys at three or four measurement points. RESULTS Complete data from 69 participants from the intervention group and from 72 participants from the control group could be evaluated. A small-sized reduction in restrictions on social participation was observed in the intervention group, whereas the reduction in the control group was negligible. The repeated-measures analysis of variance (ANOVA) showed sustained effects on the secondary outcomes, such as depression, perceived social support, and the mental health domain of quality of life of family carers, in favour of the intervention group. The results also showed that telephone-based aftercare groups had a rather minor influence on the use of support services. Except for those from family, friends and neighbours, existing support offers were hardly used. CONCLUSION Telephone aftercare group sessions for carers of people with dementia were not able to increase social participation at the expected magnitude. Nevertheless, the clear effects on selected secondary health-related outcomes and the assessment of the telephone-based group sessions by the participants show that the caring relatives were able to benefit greatly from this aftercare measure. Family carers should be informed more extensively about the corresponding resources and encouraged to use them. Overall, this new aftercare concept can be recommended for implementation, and its use also seems to be target-oriented for other indications. CLINICAL TRIAL REGISTRATION German Clinical Trials Register: DRKS00013736 , 14/05/2018.
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Affiliation(s)
- Martin Berwig
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Liebigstr 16, 04103, Leipzig, Germany. .,German Centre for Neurodegenerative Diseases (DZNE) - Site Witten, Witten, Germany. .,School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Institute of General Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - Susanne Lessing
- Clinic for Cognitive Neurology, Medical Faculty, University of Leipzig, Liebigstr 16, 04103, Leipzig, Germany
| | - Ruth Deck
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160 (Haus V50), 23538, Lübeck, Germany
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Neubert L, Gottschalk S, König HH, Brettschneider C. Dementia care-giving from a family network perspective in Germany: A typology. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:579-591. [PMID: 32939908 DOI: 10.1111/hsc.13161] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/06/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
Sustaining informal care-giving for people living with dementia (PWD) is a common objective of societies worldwide. Families can contribute substantially to the support of care-giving relatives. However, a deeper understanding of the impact of informal care-giving for PWD on family life is needed. Interviewing of multiple family network members-in addition to the primary carer-provides more insight into familial contexts of care-giving. This pilot study aims to explore how informal carers reconcile dementia care-giving and family life from a family network perspective. Therefore, we conducted 14 narrative interviews with family carers from seven care-giving networks in Germany, which we interpreted using the documentary method. The yielded relational typology describes five types of family carers of PWD. These types reflect the way the families deal with dementia care-giving based on the interrelation between relationship quality and the distribution of care-giving tasks within the family. Depending on the constellation of this interrelationship, family carers either experience care as a joint project, as co-operation with external support or within the family, as disappointment or as a predicament without alternatives. Finally, if the care-giving tasks are not shared, or if the distribution is perceived as unequal, relationship break downs can occur, especially in family ties that are already strained. However, joint care-giving and strong ties can also bring the family closer together and enhance care experiences. Care professionals and social workers should be aware of the family network of dementia carers and support the development of a sense of family unity. This can contribute to positive care experiences among family carers and thus increase the maintenance of informal dementia care.
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Affiliation(s)
- Lydia Neubert
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Perkins L, Felstead C, Stott J, Spector A. Communication training programmes for informal caregivers of people living with dementia: A systematic review. J Clin Nurs 2021; 31:2737-2753. [PMID: 34927300 DOI: 10.1111/jocn.16175] [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: 08/19/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Current research suggests that communication training programmes for caregivers of people living with dementia can benefit both parties by improving communication, quality of life and stress. Previous reviews in this area focus on mixed samples of formal and informal caregivers. This review aimed to evaluate current research for trainings specifically for informal caregivers, including the research quality and the key training components. DESIGN AND METHODS The review followed the PRISMA research reporting checklist. The electronic databases CINAHL, Embase, Medline and Psychinfo and reference lists of included literature were searched for studies relevant to the aims. Of the 45 identified studies, 36 were excluded based on pre-specified criteria. Nine studies were included in the final review and subject to quality appraisal using the Qualsyst tool. RESULTS The included studies' programmes averaged 5 to 6 hours in length over four to five sessions, were mostly face to face in both group and individual settings and were developed using various communication and psychological theories. Studies demonstrated variable quality and outcomes, making it difficult to identify optimal components. However, careful consideration of different factors enabled some suggestions for training dose, delivery method, content and outcomes to measure. CONCLUSIONS Communication training programmes can benefit people living with dementia and their informal caregivers in outcomes such as communication skills and quality of life. Suggestions are made on the training components that optimise these benefits. RELEVANCE TO CLINICAL PRACTICE Given the clear benefits on outcomes such as quality of life, there is a need for communication trainings to be offered in clinical contexts. However, given the limited pool of variable quality research and lack of accessible manuals, it is unlikely that this is the case. Consolidating and widening the evidence through further research is essential in making these trainings more widely available.
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Affiliation(s)
- Luke Perkins
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Cerne Felstead
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- School of Clinical, Educational and Health Psychology, University College London, London, UK
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Dams J, Grochtdreis T, König HH. Health-related quality of life of individuals sharing a household with persons with dementia. Qual Life Res 2021; 31:2319-2329. [PMID: 34919197 PMCID: PMC9250476 DOI: 10.1007/s11136-021-03065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
Introduction Previous research has found a negative effect of dementia on the health-related quality of life (HrQoL) of persons with dementia (PWD) and their primary informal caregivers. However, the impact of dementia on HrQoL of other individuals sharing a household with PWD has not been investigated to date. The current study therefore aimed to determine differences in the HrQoL between those sharing a household with PWD and those not living with PWD. In addition, factors related to the HrQoL of those sharing a household with PWD were evaluated. Methods The analyses were based on data from the German Socio-Economic Panel, using the SF-12 to measure HrQoL. Mixed-effects models were calculated to compare the HrQoL of those sharing a household with PWD and persons not living with PWD, as well as to determine factors related to the HrQoL of those sharing a household with PWD. Bootstrapping was used where residuals were not normally distributed. Results Mixed-effect models showed a significantly lower HrQoL among those sharing a household with PWD, compared to those not living with PWD. Number of diseases, number of persons in the household, marital status and educational level were significantly related to HrQoL among those sharing a household with PWD. Discussion The HrQoL of those sharing a household with PWD was reduced compared to persons not living with PWD. Further, those living with PWD in small households, or those with multi-morbidities had a lower HrQoL. Further research focusing on HrQoL in the social environment of PWD is needed.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Lippe M, Crowder A, Carter P, Threadgill AH. Variables Impacting the Quality of Life of Dementia Caregivers: A Data Visualization Analysis. J Nurs Scholarsh 2021; 53:772-780. [PMID: 34658133 DOI: 10.1111/jnu.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Visually explore the rates of and relationships between overall physical and mental health, sleep disturbances, and depression rates in a single sample of caregivers of persons with dementia, caregivers of persons with other chronic illness, and non-caregiving adults. DESIGN Exploratory descriptive study utilizing data visualization methods. METHODS Data were analyzed from the 2017 Behavioral Risk Factor Surveillance System dataset. Multiple graphs and charts were developed to visualize data between groups. Descriptive statistics analyzed the rates of variables of interest across the three groups. One-way analysis of variance assessed relationships between variables. RESULTS Caregivers of persons with dementia and of other chronic illnesses reported poorer health outcomes as compared to non-caregiving adults. However, caregivers of persons with other chronic illnesses reported the worst outcomes of all groups. Depression and sleep disturbances were prevalent in all three groups. CONCLUSIONS The quality of life of caregivers of persons with dementia and chronic illness is impacted by poorer health outcomes, specifically mental health and sleep. CLINICAL RELEVANCE Findings support the need for caregiver-specific interventions that target overall physical and mental health, depression, and sleep disturbances. However, we also found support for mental health and sleep interventions for all individuals.
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Affiliation(s)
- Megan Lippe
- Assistant Professor, Epsilon Omega and Epsilon Theta, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - Addison Crowder
- Research Assistant, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - Patricia Carter
- Professor and Associate Dean for Graduate Programs, Epsilon Omega, University of Alabama Capstone College of Nursing, Tuscaloosa, AL, USA
| | - A Hunter Threadgill
- Postdoctoral Fellow, Departments of Biomedical Sciences and Psychology, Florida State University, Tallahassee, Florida, USA
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Han A, Kim TH, Hong H. A factorial randomized controlled trial to examine separate and combined effects of a simulation-based empathy enhancement program and a lecture-based education program on family caregivers of people with dementia. Aging Ment Health 2021; 25:1930-1940. [PMID: 32426989 DOI: 10.1080/13607863.2020.1768214] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The present study was a 2 × 2 factorial randomized controlled trial that examined if a simulation-based empathy enhancement program and a lecture-based education program, together or separately, improved outcomes of family caregivers of people with dementia. METHOD A total of 101 participants were randomly assigned to simulation-based education only, lecture-based education only, simulation-based education plus lecture-based education, or treatment as usual. Data were analyzed using a two-way analysis of covariance while controlling for pretest results, kinship, and gender. RESULTS Statistically significant interaction effects between the simulation program and the lecture program were found in the levels of well-being and helplessness. The lecture program accompanied by the simulation program led to higher level of well-being in terms of happiness and lower level of helplessness than the lecture program alone. Caregivers with the lecture program provided led to less frequent use of dysfunctional coping strategies than those with no lecture program provided. Caregivers with the simulation program provided led to more frequent use of emotion-focused coping strategies than those with no simulation program provided. CONCLUSIONS Findings of the present study support benefits of combined of and separate simulation-based and lecture-based programs on family caregivers of people with dementia in important outcomes affecting quality of care and quality of lives in families of people with dementia. Further studies are needed to identify intervention components that can improve empathy of family caregivers of people with dementia and be embedded into a multicomponent program tailored better to families in different needs.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyeon Hong
- Department of Occupational Therapy, Yonsei University, Wonju, South Korea
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Contreras M, Mioshi E, Kishita N. Factors predicting quality of life in family carers of people with dementia: The role of psychological inflexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baby Boomers Who Provide Informal Care for People Living with Dementia in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189694. [PMID: 34574619 PMCID: PMC8467135 DOI: 10.3390/ijerph18189694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
One in four Baby Boomers fills the informal caregiver role in the United States. The objectives of this study were to estimate the prevalence of Baby Boomers who are informal caregivers for people living with dementia and compare their physical and mental health status to caregivers for persons with conditions other than dementia using 2015–2018 Behavioral Risk Factor Surveillance System data (N = 10,602). We identified caregiving status (assisting a family member/friend with a long-term illness or disability in the past month, managing personal care, and not caring for a child/grandchild) and whether the care recipient’s major health condition was dementia. We calculated weighted estimates and used chi-square tests and log-binomial regression for comparisons of selected characteristics. Among Baby Boomer caregivers, 15.4% were caring for someone with dementia. Dementia caregivers were more likely to be female, caring for a parent/parent-in-law, and providing care longer than caregivers for persons without dementia. After adjusting for sociodemographic and caregiving characteristics, the prevalence of fair/poor health, frequent mental distress, and chronic conditions were similar across types of caregivers. Although no differences in caregiver’s physical and mental health by care recipient’s dementia status were found, we should underscore the importance of maintaining Baby Boomer caregivers’ health and well-being.
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Zahir A, Staffaroni AM, Wickham RE, Quinn CM, Sapozhnikova A, Seidman J, Chiong W. Caregiver "objective attitude" toward patients with neurodegenerative disease: Consequences for caregiver strain and relationship closeness. Aging Ment Health 2021; 25:1709-1715. [PMID: 32515603 PMCID: PMC7748409 DOI: 10.1080/13607863.2020.1771541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many caregivers of patients with neurodegenerative disease experience physical and psychological strain, which is associated with negative health outcomes. Caregiver strain may be partly attributable to negative emotional responses (e.g.of resentment) to the behavioral, cognitive, and physical changes associated with patients' disease. The philosopher Peter Strawson observed that in dealing with people who have neurological impairments, we often choose to suspend such emotional responses, adopting what he labeled the "objective attitude," though this may come at the expense of our relationships with them. In this study, we assessed the mediating effect of caregivers' adoption of the objective attitude on caregiver strain and relationship closeness in the setting of disease progression. Caregivers of patients with neurodegenerative disorders (n = 215) completed the Clinical Dementia Rating, Relationship-Closeness scale, Caregiver Strain Index, and a novel questionnaire assessing the adoption of the objective attitude. A structural equation model assessing associations among these variables demonstrated good fit (χ2 (88)=164.621, p < 0.001; CFI = 0.929, RMSEA = 0.064.) and showed that adoption of the objective attitude mediated the association between disease progression and relationship closeness (total β= -0.233, 95% CI: -0.351, -0.113; indirect β= -0.483, 95% CI: -0.602, -0.364; direct β = 0.250, 95% CI: 0.117, 0.384), but did not mediate the association between disease progression and caregiver strain (total β = 0.323, 95% CI: 0.234, 0.412; indirect β = 0.089, 95% CI: -0.027, 0.206; direct β = 0.153, 95% CI: -0.043, 0.349). For future work, we propose longitudinal measurements of these constructs to test the directionality of associations and consideration of how models for caregiver support can draw upon interdisciplinary insights.
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Affiliation(s)
- Ali Zahir
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Adam M. Staffaroni
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | | | - Carson M. Quinn
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Anna Sapozhnikova
- Department of Psychiatry, University of California, San Francisco, USA
| | | | - Winston Chiong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, USA
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Shah R, Ali FM, Finlay AY, Salek MS. Family reported outcomes, an unmet need in the management of a patient's disease: appraisal of the literature. Health Qual Life Outcomes 2021; 19:194. [PMID: 34353345 PMCID: PMC8339395 DOI: 10.1186/s12955-021-01819-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A person's chronic health condition or disability can have a huge impact on the quality of life (QoL) of the whole family, but this important impact is often ignored. This literature review aims to understand the impact of patients' disease on family members across all medical specialities, and appraise existing generic and disease-specific family quality of life (QoL) measures. METHODS The databases Medline, EMBASE, CINHAL, ASSIA, PsycINFO and Scopus were searched for original articles in English measuring the impact of health conditions on patients' family members/partner using a valid instrument. RESULTS Of 114 articles screened, 86 met the inclusion criteria. They explored the impact of a relative's disease on 14,661 family members, mostly 'parents' or 'mothers', using 50 different instruments across 18 specialities including neurology, oncology and dermatology, in 33 countries including the USA, China and Australia. These studies revealed a huge impact of patients' illness on family members. An appraisal of family QoL instruments identified 48 instruments, 42 disease/speciality specific and six generic measures. Five of the six generics are aimed at carers of children, people with disability or restricted to chronic disease. The only generic instrument that measures the impact of any condition on family members across all specialities is the Family Reported Outcome Measure (FROM-16). Although most instruments demonstrated good reliability and validity, only 11 reported responsiveness and only one reported the minimal clinically important difference. CONCLUSIONS Family members' QoL is greatly impacted by a relative's condition. To support family members, there is a need for a generic tool that offers flexibility and brevity for use in clinical settings across all areas of medicine. FROM-16 could be the tool of choice, provided its robustness is demonstrated with further validation of its psychometric properties.
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Affiliation(s)
- R. Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F. M. Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A. Y. Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M. S. Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute of Medicines Development, Cardiff, UK
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Rentz DM, Wessels AM, Annapragada AV, Berger A, Edgar CJ, Gold M, Miller DS, Randolph C, Ryan JM, Wunderlich G, Zoschg MC, Trépel D, Knopman DS, Staffaroni AM, Bain LJ, Carrillo MC, Weber CJ. Building clinically relevant outcomes across the Alzheimer's disease spectrum. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12181. [PMID: 34195350 PMCID: PMC8234696 DOI: 10.1002/trc2.12181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/24/2021] [Accepted: 04/16/2021] [Indexed: 11/08/2022]
Abstract
Demonstrating that treatments are clinically meaningful across the Alzheimer's disease (AD) continuum is critical for meeting our goals of accelerating a cure by 2025. While this topic has been a focus of several Alzheimer's Association Research Roundtable (AARR) meetings, there remains no consensus as to what constitutes a "clinically meaningful outcome" in the eyes of patients, clinicians, care partners, policymakers, payers, and regulatory bodies. Furthermore, the field has not come to agreement as to what constitutes a clinically meaningful treatment effect at each stage of disease severity. The AARR meeting on November 19-20, 2019, reviewed current approaches to defining clinical meaningfulness from various perspectives including those of patients and care partners, clinicians, regulators, health economists, and public policymakers. Participants discussed approaches that may confer clinical relevance at each stage of the disease continuum and fostered discussion about what should guide us in the future.
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Affiliation(s)
- Dorene M. Rentz
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Center for Alzheimer Research and TreatmentDepartment of NeurologyBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Ananth V. Annapragada
- E.B. Singleton Department of RadiologyTexas Children's Hospital & Baylor College of MedicineHoustonTexasUSA
| | | | | | | | | | - Christopher Randolph
- WCG MedAvante‐ProPhaseHamiltonNew JerseyUSA
- Department of NeurologyLoyola University Medical CenterMaywoodIllinoisUSA
| | | | | | | | - Dominic Trépel
- Global Brain Health InstituteTrinity College DublinDublinIreland
- School of MedicineTrinity College DublinUniversity of DublinDublinIreland
| | | | - Adam M. Staffaroni
- Memory and Aging CenterDepartment of NeurologyWeill Institute for NeurosciencesUniversity of California, San FranciscoSan FranciscoUSA
| | - Lisa J. Bain
- Independent Science WriterElversonPennsylvaniaUSA
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Physical activity for people living with dementia: carer outcomes and side effects from the perspectives of professionals and family carers. Aging Clin Exp Res 2021; 33:1267-1274. [PMID: 32621269 PMCID: PMC8081678 DOI: 10.1007/s40520-020-01636-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/16/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Adherence to physical activity is challenging for people living with dementia, and largely dependent on carers' involvement. Carers are likely to support physical activity based on their perceived balance between benefits and potential side effects of such intervention for both patients and themselves. Professionals also have a role in terms of optimising such interventions not only for people with dementia but also their carers. AIMS The present study aimed to identify the priorities of carers and professionals regarding (1) outcomes of physical activity for people living with dementia on carers and (2) side effects on patients and carers. METHODS This was a two-round prioritisation exercise. In round one, participants were asked to rank, from most to least important, 2 lists of outcomes generated in a previous systematic review and qualitative study: (i) 10 outcomes on carers; (ii) 17 side effects on patients and carers. In round two, participants were asked to consider their own ranking in round one against the overall group ranking and re-rank both lists. RESULTS 36 carers and 39 professionals completed both rounds. The carer outcomes ranked as highest priority were "carer feeling positive and satisfied", "carer improving wellbeing" and "making lives of carers easier". The most undesirable side effects were "becoming agitated and confused", "falling over" and "feeling discomfort and pain". DISCUSSION AND CONCLUSIONS Carers and professionals value the potential reduction in carer burden that may occur as a consequence of the person with dementia engaging in physical activity. Behavioural and psychological symptoms, falls and pain are the most undesirable side effects of physical activity. Future research should aim to address, and consistently report on these outcomes.
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Gottschalk S, Neubert L, König HH, Brettschneider C. Balancing care demands and personal needs: A typology on the reconciliation of informal dementia care with personal life based on narrative interviews. DEMENTIA 2021; 20:2689-2707. [PMID: 33847550 PMCID: PMC8670745 DOI: 10.1177/14713012211008306] [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] [Indexed: 11/21/2022]
Abstract
Finding a balance between care and personal needs is often challenging for individuals caring for a person with dementia. The present study aimed to understand how primary and secondary family carers of people with dementia perceive the reconciliation of informal care and their personal life throughout the course of care. Narrative interviews with 14 carers (n=10 female, mean age: 48.79) from seven care networks were conducted. The interviews were analysed using the documentary method. The result was a relational type formation which comprises different process types: ‘Respect your boundaries, stay calm, but plan ahead’, ‘Acting strategic is making it work’, ‘Reflect the situation, deal with it, and pull it through’ and ‘There is no alternative, you have to live with it’. This typology was based on two related dimensions: the way people negotiate their own needs against the demands of care (prospective, strategic, reflective and limited) and the resulting attitudes towards reconciling informal care and personal life (accepting, withstanding and enduring). The results yield implications for practice, such as considering individual needs and the care network to provide effective support and promoting the importance of self-care behaviours to achieve a balance between care and personal life.
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Affiliation(s)
- Sophie Gottschalk
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Lydia Neubert
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, 37734University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany
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Durepos P, Akhtar-Danesh N, Ploeg J, Sussman T, Kaasalainen S. Caring ahead: Mixed methods development of a questionnaire to measure caregiver preparedness for end-of-life with dementia. Palliat Med 2021; 35:768-784. [PMID: 33619975 PMCID: PMC8022086 DOI: 10.1177/0269216321994732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. AIM To develop a multi-dimensional questionnaire titled 'Caring Ahead' to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. DESIGN A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. SETTING/POPULATION Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. RESULTS Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the 'Caring Ahead' preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. CONCLUSIONS Family caregivers' feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.
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Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
- Aging, Community and Health Research Unit, Hamilton, ON, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QB, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
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Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, Chmelirsch C, Seebahn K, Hladik M, Meuer S, Kirchner A, Holm K, Selau M, Wendel M, Trinkwalter J, Prokosch HU, Graessel E, Kolominsky-Rabas PL. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11:e043473. [PMID: 33558357 PMCID: PMC7871684 DOI: 10.1136/bmjopen-2020-043473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dementia is one of the most relevant widespread diseases, with a prevalence of currently 50 million people with dementia worldwide. The care of people with dementia will be one of the major challenges for healthcare systems worldwide. Digitalisation offers new possibilities to improve both dementia healthcare and health outcomes research as a fundament for national healthcare planning. The 'Digital Dementia Registry Bavaria-digiDEM Bayern' aims to improve the understanding of the complexity and long-term progression of dementia and the current care situation in Bavaria. Moreover, by offering digital services, digiDEM will actively contribute to improving the care situation in Bavaria. METHODS AND ANALYSIS: digiDEM will recruit people with dementia and their family caregivers in all administrative regions of Bavaria. All participants will undergo dementia screening prior to study inclusion in order to identify people with mild cognitive impairment and mild-to-moderate dementia. Participants will be followed up over a period of three years. Sociodemographic data, type of dementia, symptoms, diagnosis, cognitive trajectories, activities of daily living, behavioural and psychological symptoms, falls, resource utilisation, caregiver burden, quality of life, needs of people with dementia and their caregivers, mobility, use of media and sources of information will be assessed. The project will implement a digital web-based platform for data collection. Data will be collected by means of standardised online or face-to-face interviews. ETHICS AND DISSEMINATION The study obtained ethical approval from the Ethics Committee of the Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B). Findings will be used for evidence-based decision-making for health decision-makers in order to optimise dementia healthcare in the state of Bavaria. Specific analyses will be conducted for the participating research partners. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Kürten
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Linda Karrer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Reichold
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Köhler
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Andreas Nagel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christina Chmelirsch
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin Seebahn
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Hladik
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meuer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Kirchner
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kristina Holm
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Selau
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Wendel
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Jörg Trinkwalter
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Wiegelmann H, Speller S, Verhaert LM, Schirra-Weirich L, Wolf-Ostermann K. Psychosocial interventions to support the mental health of informal caregivers of persons living with dementia - a systematic literature review. BMC Geriatr 2021; 21:94. [PMID: 33526012 PMCID: PMC7849618 DOI: 10.1186/s12877-021-02020-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Background Informal caregivers of persons living with dementia have an increased risk of adverse mental health effects. It is therefore important to systematically summarize published literature in order to find out which mental health interventions generate effective support for informal caregivers of persons living with dementia. The objective of this study is to conduct a systematic review of intervention content, effectiveness and subgroup differentiation of mental health interventions for informal caregivers of persons with dementia living at home. Method We searched four electronic databases (PubMed, PsychINFO, Scopus and CINAHL) and included only methodically high-quality randomized controlled trials (RCTs), published in English or German language between 2009 and 2018. The intervention programmes focused on mental health of family caregivers. A narrative synthesis of the included studies is given. Results Forty-eight publications relating to 46 intervention programmes met the inclusion criteria. Burden, depression and quality of life (QoL) are the predominant parameters that were investigated. Twenty-five of forty-six interventions (54.3%) show positive effects on at least one of the outcomes examined. Most often, positive effects are reported for the outcome subjective burden (46.2%). Only six studies explicitly target on a certain subgroup of informal dementia caregivers (13%), whereas all other interventions (87%) target the group as a whole without differentiation. Conclusion The most beneficial results were found for cognitive behavioural approaches, especially concerning the reduction of depressive symptoms. Besides this, leisure and physical activity interventions show some good results in reducing subjective caregiver burden. In order to improve effectiveness, research and practice may focus on developing more targeted interventions for special dementia informal caregiver subgroups. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02020-4.
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Affiliation(s)
- Henrik Wiegelmann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany.
| | - Sarah Speller
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
| | - Lisa-Marie Verhaert
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Liane Schirra-Weirich
- Department of Social Services, Centre for Participation Research, Catholic University of Applied Sciences of North Rhine-Westphalia, Robert-Schuman-Straße 25, 52066, Aachen, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Grazer Straße 4, 28359, Bremen, Germany
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Parajuli DR, Kuot A, Hamiduzzaman M, Gladman J, Isaac V. Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes. BMC Psychiatry 2021; 21:36. [PMID: 33441109 PMCID: PMC7805083 DOI: 10.1186/s12888-020-03033-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the 'Harmony in the Bush Dementia Study'. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. METHODS Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. RESULTS The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer's disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents' medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. CONCLUSIONS Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. TRIAL REGISTRATION ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.
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Affiliation(s)
- Daya Ram Parajuli
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia.
| | - Abraham Kuot
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Mohammad Hamiduzzaman
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Justin Gladman
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
| | - Vivian Isaac
- College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia
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Liu HY, Hsu WC, Shyu YIL, Wang YN, Huang TH, Lin YE, Huang CH. Finding a balance in family caregiving for people with dementia: A correlational longitudinal study. J Adv Nurs 2021; 77:2278-2292. [PMID: 33434343 DOI: 10.1111/jan.14747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN A correlational longitudinal design was used. METHODS Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
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Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yu-Nu Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.)
| | - Tzu-Hsin Huang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Yueh-E Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Hsia Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
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Kaskie B, Bobitt J, Herrera J, Bhagianadh D, Segal-Gidan F, Brummel-Smith K, Arora K. Cannabis Use among Persons with Dementia and Their Caregivers: Lighting up an Emerging Issue for Clinical Gerontologists. Clin Gerontol 2021; 44:42-52. [PMID: 33250000 DOI: 10.1080/07317115.2020.1852465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: Our goal is to illuminate cannabis use among persons with dementia (PwD) and their informal caregivers relative to the use of evidence-based as well as other complementary and alternative care practices. Methods: We analyzed focus group (FG) narratives provided by 26 caregivers of PwD and identified five themes concerning the provision of cannabis to PwD and caregivers' self-use. Results: Three of the 26 caregivers provided PwD cannabis and also used themselves, another 3 of the 26 used themselves only, and all but two of the remaining FG participants indicated they would consider providing cannabis to PwD or using for themselves. These caregivers expressed a desire to obtain more empirically-based information about cannabis and to discuss options with their clinical care providers. Conclusions: A small but significant proportion of caregivers are providing cannabis to PwD as a possible treatment for agitation, sleep disturbances and other problematic secondary symptoms and using for themselves as way to relieve stress. Many other caregivers may start using cannabis upon receiving information and guidance from a credible source. Clinical Implications: Notwithstanding the need for more research, clinical gerontologists and other dementia care specialists are being looked upon to provide information and guidance about the benefits and harms of cannabis use among PwD and their caregivers.
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A validation study of the CarerQol instrument in informal caregivers of people with dementia from eight European countries. Qual Life Res 2020; 30:577-588. [PMID: 33113082 PMCID: PMC7886819 DOI: 10.1007/s11136-020-02657-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 10/29/2022]
Abstract
PURPOSE Informal care constitutes an important part of the total care for people with dementia. Therefore, the impact of the syndrome on their caregivers as well as that of health and social care services for people with dementia should be considered. This study investigated the convergent and clinical validity of the CarerQol instrument, which measures and values the impact of providing informal care, in a multi-country sample of caregivers for people with dementia. METHODS Cross-sectional data from a sample of 451 respondents in eight European countries, collected by the Actifcare project, were evaluated. Convergent validity was analysed with Spearman's correlation coefficients and multivariate correlations between the CarerQol-7D utility score and dimension scores, and other similar quality of life measures such as CarerQol-VAS, ICECAP-O, and EQ-5D. Clinical validity was evaluated by bivariate and multivariate analyses of the degree to which the CarerQol instrument can differentiate between characteristics of caregivers, care receivers and caregiving situation. Country dummies were added to test CarerQol score differences between countries. RESULTS The mean CarerQol utility score was 77.6 and varied across countries from 74.3 (Italy) to 82.3 (Norway). The scores showed moderate to strong positive correlations with the CarerQol-VAS, ICECAP-O, and EQ-5D health problems score of the caregiver. Multivariate regression analysis showed that various characteristics of the caregiver, care receiver and caregiving situation were associated with caregiver outcomes, but there was no evidence of a country-level effect. CONCLUSION This study demonstrates the convergent and clinical validity of the CarerQol instrument to evaluate the impact of providing informal care for people with dementia.
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Frias CE, Cabrera E, Zabalegui A. Informal Caregivers' Roles in Dementia: The Impact on Their Quality of Life. Life (Basel) 2020; 10:life10110251. [PMID: 33113995 PMCID: PMC7690694 DOI: 10.3390/life10110251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022] Open
Abstract
The constantly changing process of caring for a person with dementia affects the informal caregivers’ role due to its psychosocial impact. This cross-sectional study aimed to analyze the impact of the Person with Dementia informal caregiver’s role caregiver to a person with dementia on the self-perceived quality of life (QoL) of the caregiver. In total, 160 informal caregivers were recruited between January and December 2019. Informal caregivers’ quality of life was assessed using the European Quality of Life 5-Dimension scale, burden with the Zarit Burden Scale, emotional wellbeing using the General Health Questionnaire, and caregiver reactions using Caregiver Reaction Aspects. Patients’ cognitive impairment was assessed with the Mini-Mental State Examination, their quality of life using Quality of Life in Alzheimer’s Disease, and neuropsychiatric symptoms using the Neuropsychiatric Inventory. Outcomes were studied using the Pearson correlation coefficient and ANOVA test. Most informal caregivers’ outcomes were significantly associated with their quality of life. Male informal caregivers have a slightly better quality of life than female caregivers (p < 0.001). Caregiver burden (p < 0.001), psychological wellbeing (p < 0.001) and negative aspects of caregiving on health (p < 0.001) correlated moderately with informal caregivers’ quality of life. Factors associated with dementia, including the course of the illness and its severity with the presence of neuropsychiatric symptoms can negatively affect the informal caregiver’s role and produce a low self-perception of quality of life; thus, social and professional support for informal caregivers is essential.
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Affiliation(s)
- Cindy E. Frias
- Mental Health Nurse, Hospital Clinic, 08036 Barcelona, Spain;
- School of Health Sciences, University of Barcelona, 08036 Barcelona, Spain
| | - Esther Cabrera
- School of Health Sciences, TecnoCampus Universitat, Pompeu Fabra, 08301 Mataró, Spain;
- Department of Care Management and Social Work, Sechenov University, Moscow 101000, Russia
| | - Adelaida Zabalegui
- School of Health Sciences, University of Barcelona, 08036 Barcelona, Spain
- Department of Nursing, Hospital Clínic de Barcelona, 08001 Barcelona, Spain
- Correspondence:
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Effects of acceptance and commitment therapy on process measures of family caregivers: A systematic review and meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Durepos P, Ploeg J, Sussman T, Akhtar-Danesh N, Kaasalainen S. "A Crazy Roller Coaster at the End": A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia. SAGE Open Nurs 2020; 6:2377960820949111. [PMID: 33415300 PMCID: PMC7774442 DOI: 10.1177/2377960820949111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Caregivers of persons with dementia experience challenges that can make
preparing for end-of-life particularly difficult. Feeling prepared for death
is associated with caregiver well-being in bereavement and is promoted by
strategies supporting a palliative approach. Further conceptualization of
caregiver preparedness for death of persons with dementia is needed to guide
the practice of healthcare providers and to inform development of a
preparedness questionnaire. Objectives We aimed to: 1) explore the end-of-life experiences of caregivers of persons
with dementia to understand factors perceived as influencing preparedness;
and 2) identify the core concepts (i.e., components), barriers and
facilitators of preparedness for death. Methods This study used an interpretive descriptive design. Semi-structured
interviews were conducted with sixteen bereaved caregivers of persons with
dementia, recruited from long-term care homes in Ontario. Data was analyzed
through reflexive thematic analysis. Findings Four themes were interpreted including: ‘A crazy rollercoaster at the end’
which described the journey of caregivers at end-of-life. The journey
provided context for the development of core concepts (i.e., components) of
preparedness represented by three themes: ‘A sense of control, ‘Doing right’
and ‘Coming to terms’. Conclusion The study findings serve to expand the conceptualization of preparedness and
can guide improvements to practice in long-term care. Core concepts,
facilitators and influential factors of preparedness will provide the
conceptual basis and content to develop the Caring Ahead: Preparing for
End-of-Life with Dementia questionnaire.
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Affiliation(s)
- Pamela Durepos
- School of Nursing, Faculty of Health Sciences, McMaster University.,Canadian Frailty Network, Kingston, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | | | - Noori Akhtar-Danesh
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
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Teles S, Paúl C, Sosa Napolskij M, Ferreira A. Dementia caregivers training needs and preferences for online interventions: A mixed-methods study. J Clin Nurs 2020; 31:2036-2054. [PMID: 32757354 DOI: 10.1111/jocn.15445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
AIM To explore how informal caregivers of persons with dementia perceive training needs and preferences in the context of online training and support interventions. BACKGROUND Informal dementia caregivers commonly present high needs across several domains. Paradoxically, they are more likely to have unmet needs and lower levels of service usage when compared to other caregivers. Most studies on unmet needs of dementia caregivers have been quantitative and resorted to assessment checklists, with a minority focusing on subjective needs. DESIGN Mixed-methods. METHODS Eighty-eight Portuguese digitally literate caregivers filled a web-based questionnaire collecting written statements on training needs and importance ratings on design preferences. Content analysis of text data was carried out by two independent researchers to check the reliability of the analytic process. Descriptive statistics were produced for ratings on design preferences, and associations with caregivers' sociodemographic and care-related variables were inspected. Reporting followed the criteria for reporting qualitative research checklist. RESULTS Five main categories of training needs have emerged: knowledge of dementia; care interactions; caregiver self-care; community resources; and laws or regulations affecting the caregiver and the care recipient. The most reported need was on care interactions, on the subcategory of providing good quality care. Thematic prominence was analysed according to the caregiver, caregiving and health perception characteristics, with trends found on formal education, relationship with the care recipient, number of hours caring per week, perceived level of dependence of the care recipient and perceived physical and psychological health status of the caregiver. Most valued design features included the use of plain language, easy to interact interface and communication with a professional. CONCLUSIONS Findings from this study further support the delivery of comprehensive interventions addressing the multiple needs of caregivers. RELEVANCE TO CLINICAL PRACTICE Clues are provided for the delivery of online interventions, and conclusions are useful to health professionals working with dementia caregivers.
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Affiliation(s)
- Soraia Teles
- Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto (ICBAS-UP), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Constança Paúl
- Institute of Biomedical Sciences Abel Salazar, Department of Behavioral Sciences, University of Porto (ICBAS-UP), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Milaydis Sosa Napolskij
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Ana Ferreira
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
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