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Zhu X, Chen S, He M, Dong Y, Fang S, Atigu Y, Sun J. Life experience and identity of spousal caregivers of people with dementia: A qualitative systematic review. Int J Nurs Stud 2024; 154:104757. [PMID: 38552470 DOI: 10.1016/j.ijnurstu.2024.104757] [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: 08/12/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The number of people with dementia is on the rise worldwide, and dementia care has become the focus of global health services. People with dementia are primarily cared for by informal caregivers, with spouses seen as a particularly vulnerable group. Focusing on the spousal caregiving experience and having a good caregiver identity contributes to group bonding and enhanced social support. OBJECTIVE To explore the dynamic changes that occur in the caregiving experience of spouse caregivers and explicate the identity of spouses during this process alongside its causes. DESIGN A qualitative systematic review. DATA SOURCE The following eight electronic databases were searched: PubMed, Web of Science (Core Collection), The Cochrane Library, Embase, CINAHL and CNKI, WanFang and Vip. REVIEW METHODS The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and Joanna Briggs Institute Reviewer's Manual criteria were used to report the results. Study screening and data extraction were conducted independently by two reviewers, and quality was assessed using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool. Data synthesis was performed using thematic analysis. RESULTS A total of 15 studies were included and synthesized into three analytical themes: (1) attitudes and emotions toward dementia, (2) emotional ups and downs in dementia care, and (3) who am "I". In binary care, patience and marital responsibilities are identified as facilitators, while care burden and social isolation are identified as hindrances. In addition, gender differences were identified as influencers of identity. CONCLUSIONS In this review, spouse identity of people with dementia is complex and affects caregiving experience together with dementia cognition. Disease cognition, caregiving burden and social isolation are identified. Interventions for barriers are suggested to enhance social support.
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Affiliation(s)
- Xiangning Zhu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Si Chen
- The First Bethune Hospital of Jilin University, No.126 Xinmin Street, Changchun 130021, Jilin, People's Republic of China
| | - Meng He
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yueyang Dong
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Shuyan Fang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yiming Atigu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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Mechanic-Hamilton D, Lydon S, Xie SX, Zhang P, Miller A, Rascovsky K, Rhodes E, Massimo L. Turning apathy into action in neurodegenerative disease: Development and pilot testing of a goal-directed behaviour app. Neuropsychol Rehabil 2024; 34:469-484. [PMID: 37128648 PMCID: PMC10600325 DOI: 10.1080/09602011.2023.2203403] [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: 09/05/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
This study aims to design and pilot an empirically based mobile application (ActiviDaily) to increase daily activity in persons with apathy and ADRD and test its feasibility and preliminary efficacy. ActiviDaily was developed to address impairments in goal-directed behaviour, including difficulty with initiation, planning, and motivation that contribute to apathy. Participants included patients with apathy and MCI, mild bvFTD, or mild AD and their caregivers. In Phase I, 6 patient-caregiver dyads participated in 1-week pilot testing and focus groups. In Phase II, 24 dyads completed 4 weeks of at-home ActiviDaily use. Baseline and follow-up visits included assessments of app usability, goal attainment, global cognition and functioning, apathy, and psychological symptoms. App use did not differ across diagnostic groups and was not associated with age, sex, education, global functioning or neuropsychiatric symptoms. Patients and care-partners reported high levels of satisfaction and usability, and care-partner usability rating predicted app use. At follow-up, participants showed significant improvement in goal achievement for all goal types combined. Participant goal-directed behaviour increased after 4 weeks of ActiviDaily use. Patients and caregivers reported good usability and user satisfaction. Our findings support the feasibility and efficacy of mobile-health applications to increase goal-directed behaviour in ADRD.
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Affiliation(s)
- Dawn Mechanic-Hamilton
- Penn Memory Center, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Sean Lydon
- Penn Memory Center, Perelman School of Medicine, University of Pennsylvania
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Sharon X. Xie
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Panpan Zhang
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Alex Miller
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Emma Rhodes
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
| | - Lauren Massimo
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania
- School of Nursing, University of Pennsylvania
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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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Oh E, Moon S, Chung D, Choi R, Hong GRS. The moderating effect of care time on care-related characteristics and caregiver burden: differences between formal and informal caregivers of dependent older adults. Front Public Health 2024; 12:1354263. [PMID: 38638476 PMCID: PMC11024244 DOI: 10.3389/fpubh.2024.1354263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
Objective This study examined differences in care burden between formal and informal caregivers of dependent older adults according to care-related characteristics, and whether care time had a moderating effect on the relationship between care-related characteristics and caregiver burden. Methods Participants were formal (n = 520) and informal caregivers (n = 142) of dependent older adults in South Korea. Caregiver burden was measured using the Korean version of the Zarit Burden Interview. Data were analyzed using hierarchical regression with interaction terms and moderation analysis. Results Caregiver burden was higher for informal caregivers than formal caregivers. Factors associated with an increased risk of caregiver burden in both formal and informal caregiver of dependent older adults were caregivers' stress, physical strain, and care time. Care time significantly moderated the relationship between care attitude and care burden only among formal caregivers. When formal caregivers' care time was 1 standard deviation higher than the mean value, care attitude was significantly associated with care burden (bsimple = -0.903, SE = 0.106, p < 0.001). Conclusion The caregiver burden of dependent older adults can be reduced by providing interventions to attenuate the effects of modifiable risk factors that were identified in this study. And to weaken the relationship between care attitude and burden of formal caregivers who have long care hours, a positive social atmosphere for care should be provided in addition to education. To realize sustainable care, policy considerations that reflect the results of this study will help solve the problem of formal and informal caregiver burden of dependent older adults.
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Affiliation(s)
- Eunmi Oh
- Research Institute of Nursing Science, Hanyang University, Seoul, Republic of Korea
| | - SeolHwa Moon
- Department of Nursing, Hoseo University, Cheonan-si, Republic of Korea
| | - Daum Chung
- College of Nursing, Hanyang University, Seoul, Republic of Korea
| | - Rina Choi
- College of Nursing, Hanyang University, Seoul, Republic of Korea
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Liao ZY, Sun SJ, Clarissa C, Aviles L, Lin CP, Kao CT, Shih YH, Lo YS, Chen LYA. Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era. J Formos Med Assoc 2024:S0929-6646(24)00181-5. [PMID: 38570237 DOI: 10.1016/j.jfma.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024] Open
Abstract
In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses.
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Affiliation(s)
- Zih-Yong Liao
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan.
| | - Shao-Jun Sun
- Nursing Department, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Hospital Union, Taipei, Taiwan.
| | - Catherine Clarissa
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK; Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
| | - Lissette Aviles
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK.
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
| | - Ching Ting Kao
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Yun-Hsuan Shih
- Nursing Department, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yun-Sheng Lo
- National Taiwan University Cancer Center, Taipei, Taiwan; Taiwan Nurses Union, Taiwan.
| | - Lu-Yen Anny Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Parrotta I, Cacciatore S, D'Andrea F, D'Anna M, Giancaterino G, Lazzaro G, Arcara G, Manzo N. Prevalence, treatment, and neural correlates of apathy in different forms of dementia: a narrative review. Neurol Sci 2024; 45:1343-1376. [PMID: 38015288 PMCID: PMC10942903 DOI: 10.1007/s10072-023-07197-7] [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: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The aim of this review is to provide an overview on prevalence and clinical tools for the diagnosis of apathy, as well as on neurophysiological and neuroimaging findings obtained from studies in patients with apathy in different forms of dementia, including Alzheimer's disease (AD), vascular (VaD) and mixed dementia, frontotemporal dementia (FTD), and Parkinson's disease dementia (PDD). METHODS Randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series from four databases (WebOfScience, Scopus, Pubmed, and PsycINFO) addressing apathy in adults or older people aged over 65 years of age affected by dementia were included. RESULTS The prevalence of apathy was 26-82% for AD, 28.6-91.7 for VaD, 29-97.5% in PDD, and 54.8-88.0 in FTD. The assessment of apathy was not consistent in the reviewed studies. Methylphenidate was the most successful pharmacological treatment for apathy. Neurobiological studies highlighted the relationship between both structural and functional brain areas and the presence or severity of apathy. CONCLUSION Apathy is a very common disorder in all types of dementia, although it is often underdiagnosed and undertreated. Further studies are needed to investigate its diagnosis and management. A consensus on the different evaluation scales should be achieved.
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Affiliation(s)
- Ilaria Parrotta
- Movement Control and Neuroplasticity Research Group, Tervuursevest 101, 3001, Louvain, Belgium
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy
| | - Stefano Cacciatore
- Young Epidemiologists of the Italian Society of Gerontology and Geriatrics (SIGG) (YES) Working Group, Italian Society of Gerontology and Geriatrics, Via Giulio Cesare Vanini 5, 50129, Florence, Italy.
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168, Rome, Italy.
| | - Flavio D'Andrea
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Marianna D'Anna
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giulia Giancaterino
- Department of Human Neuroscience, Sapienza University, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giovanni Lazzaro
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
| | - Nicoletta Manzo
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Italy
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McGee JS, Polson EC, Myers DR, McClellan A, Meraz R, Ke W, Zhao HC. Hope Mediates Stress to Reduce Burden in Family Caregivers of Persons with Alzheimer's Disease. Geriatrics (Basel) 2024; 9:38. [PMID: 38525755 PMCID: PMC10961813 DOI: 10.3390/geriatrics9020038] [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: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
The experience of burden among family caregivers of persons with Alzheimer's disease and other forms of dementia may be deleterious for their health and well-being. Little is known, however, about the degree to which internal positive psychological resources, such as hope, influence burden perceptions in this population. The current study is novel in that it examined how multiple dimensions of hope, hope-agency and hope-pathway, influenced burden in a sample of one-hundred and fifty-five family caregivers of persons with Alzheimer's disease. The stress process model was used as the theoretical framework for variable specification in this study. Hope was conceptualized using Snyder and colleagues' hope theory. Supporting our first hypothesis, we found that burden was negatively associated with hope-agency, r = -0.33, p < 0.001 and hope-pathway, r = -0.24, p < 0.01. Multiple regression was used to determine if hope-agency and hope-pathway independently contributed to burden. Analysis revealed that hope-agency but not hope-pathway influenced burden when other key variables were taken into consideration. Findings from mediation analysis affirmed that hope-agency had a small but significant mediation effect between stress and burden in this sample. This study provides evidence for the relevance of assessing multiple dimensions of hope when working with caregivers of persons with Alzheimer's. Although replication studies are warranted, the current study confirms a need for further development and refinement of hope-bolstering behavioral interventions which may mediate stress and burden in this population. These interventions should be systematically assessed for efficacy and effectiveness via implementation studies in real-world settings.
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Affiliation(s)
- Jocelyn Shealy McGee
- Garland School of Social Work, Baylor University, Waco, TX 76701, USA; (E.C.P.); (D.R.M.); (A.M.)
| | - Edward C. Polson
- Garland School of Social Work, Baylor University, Waco, TX 76701, USA; (E.C.P.); (D.R.M.); (A.M.)
| | - Dennis R. Myers
- Garland School of Social Work, Baylor University, Waco, TX 76701, USA; (E.C.P.); (D.R.M.); (A.M.)
| | - Angela McClellan
- Garland School of Social Work, Baylor University, Waco, TX 76701, USA; (E.C.P.); (D.R.M.); (A.M.)
| | - Rebecca Meraz
- Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA; (R.M.); (W.K.)
| | - Weiming Ke
- Louise Herrington School of Nursing, Baylor University, Dallas, TX 75246, USA; (R.M.); (W.K.)
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Pavarini SCI, Gratão ACM, Campos CRF, Monteiro DQ, Barham EJ, Orlandi FDS, Martins G, Barbosa GC, da Cruz KCT, Corrêa L, da Rocha LA, Alves LCDS, Ottaviani AC. Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study. SAO PAULO MED J 2024; 142:e2023325. [PMID: 38511815 PMCID: PMC10950309 DOI: 10.1590/1516-3180.2023.0325.r1.23012024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience. OBJECTIVE To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia. DESIGN AND SETTING A methodological study was conducted at the Federal University of São Carlos. METHODS The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test. RESULTS Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes. CONCLUSION The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.
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Affiliation(s)
- Sofia Cristina Iost Pavarini
- PhD. Nurse, Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | | | - Camila Rafael Ferreira Campos
- PhD. Psychologist, Postdoctoral Fellow, Postgraduate Program in Psychology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Diana Quirino Monteiro
- PhD. Gerontologist, Postdoctoral Fellow, Department of Gerontology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Elizabeth Joan Barham
- PhD. Psychologist, Associate Professor, Department of Psychology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Fabiana de Souza Orlandi
- PhD. Nurse, Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Gabriela Martins
- MSc. Gerontologist, PhD student, Postgraduate Program in Nursing, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Gustavo Carrijo Barbosa
- MSc. Physiotherapist, PhD student, Postgraduate Program in Nursing, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | | | - Larissa Corrêa
- MSc. Gerontologist, PhD student, Postgraduate Program in Nursing, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Luana Aparecida da Rocha
- MSc. Gerontologist, PhD student, Postgraduate Program in Nursing, Universiade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Ludmyla Caroline de Souza Alves
- MSc. Gerontologist, PhD student, Postgraduate Program in Nursing, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
| | - Ana Carolina Ottaviani
- PhD. Gerontologist, Postdoctoral Fellow, Department of Gerontology, Universidade Federal de São Carlos (UFSCAR), São Carlos (SP), Brazil
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Ilaghi M, Gharib F, Pirani A, Vahabie AH, Grafman J, Shariat SV, Shariati B, Jahanbakhshi A, Mirfazeli FS. The burden of traumatic brain injury on caregivers: exploring the predictive factors in a multi-centric study. BMC Psychol 2024; 12:150. [PMID: 38491536 PMCID: PMC10941615 DOI: 10.1186/s40359-024-01652-6] [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: 06/09/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide. With survivors often exhibiting degrees of function loss, a significant burden is exerted on their caregivers. The purpose of this study was to explore the predictive factors of caregiver burden among caregivers of patients with TBI. METHODS Sixty-eight family members of individuals with a TBI who had been admitted to three hospitals were assessed in terms of caregiver burden using the Zarit Burden Interview. The association of caregiver burden with patients' baseline cognitive function according to the Montreal Cognitive Assessment (MoCA) test, as well as caregivers' sociodemographic characteristics, were evaluated using multiple regression analysis. RESULTS Based on the multiple regression model, the MoCA score of the patients (std β=-0.442, p < 0.001), duration of caregiving (std β = 0.228, p = 0.044), and higher education of the caregivers (std β = 0.229, p = 0.038) were significant predictors of caregiver burden. CONCLUSION Overall, our findings highlight the importance of taking caregivers' psychosocial needs into account. Long-term caregivers of TBI patients with cognitive impairment should be viewed as vulnerable individuals who could benefit from psychosocial intervention programs, to improve their well-being and enabling them to enrich their care of the TBI patient.
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Affiliation(s)
- Mehran Ilaghi
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farhad Gharib
- Mental Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pirani
- Mental Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdol-Hossein Vahabie
- School of Electrical and Computer Engineering (ECE), College of Engineering, University of Tehran, Tehran, Iran
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Jordan Grafman
- Shirly Ryan AbilityLab, Departments of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology, and Alzheimer's Center, Chicago, IL, USA
- Department of Psychiatry, Feinberg School of Medicine, Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Seyed Vahid Shariat
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Shariati
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Amin Jahanbakhshi
- Skull Base Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
- National Brain Centre, Iran University of Medical Sciences, Tehran, Iran.
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Castillo LIR, Tran V, Brachaniec M, Chambers CT, Chessie K, Couros A, LeRuyet A, LeRuyet C, Thorpe L, Williams J, Wheelwright S, Hadjistavropoulos T. The #SeePainMoreClearly Phase II Pain in Dementia Social Media Campaign: Implementation and Evaluation Study. JMIR Aging 2024; 7:e53025. [PMID: 38329793 PMCID: PMC10884893 DOI: 10.2196/53025] [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: 09/22/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Social media platforms have been effective in raising awareness of the underassessment and undertreatment of pain in dementia. OBJECTIVE After a successful pilot campaign, we aimed to scale our pain-in-dementia knowledge mobilization pilot initiative (ie, #SeePainMoreClearly) to several social media platforms with the aid of a digital media partner. The goal of the initiative was to increase awareness of the challenges in the assessment and management of pain among people with dementia. A variety of metrics were implemented to evaluate the effort. Through this work, we endeavored to highlight key differences between our pilot initiative (which was a grassroots initiative), focusing largely on Twitter and YouTube, and the current science-media partnership. We also aimed to generate recommendations suitable for other social media campaigns related to health or aging. METHODS Evidence-based information about pain in dementia was summarized into engaging content (eg, videos) tailored to the needs of various knowledge users (eg, health professionals, families, and policy makers). We disseminated information using Facebook (Meta Platforms), Twitter (X Corp), YouTube (Alphabet Inc), Instagram (Meta Platforms), and LinkedIn (LinkedIn Corp) and measured the success of the initiative over a 12-month period (2020 to 2021). The evaluation methods focused on web analytics and questionnaires related to social media content. Knowledge users' web responses about the initiative and semistructured interviews were analyzed using thematic analysis. RESULTS During the course of the campaign, >700 posts were shared across all platforms. Web analytics showed that we drew >60,000 users from 82 countries to our resource website. Of the social media platforms used, Facebook was the most effective in reaching knowledge users (ie, over 1,300,000 users). Questionnaire responses from users were favorable; interview responses indicated that the information shared throughout the initiative increased awareness of the problem of pain in dementia and influenced respondent behavior. CONCLUSIONS In this investigation, we demonstrated success in directing knowledge users to a resource website with practical information that health professionals could use in patient care along with pain assessment and management information for caregivers and people living with dementia. The evaluation metrics suggested no considerable differences between our pilot campaign and broader initiative when accounting for the length of time of each initiative. The limitations of large-scale health campaigns were noted, and recommendations were outlined for other researchers aiming to leverage social media as a knowledge mobilization tool.
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Affiliation(s)
- Louise I R Castillo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Vivian Tran
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Mary Brachaniec
- Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health, Halifax, NS, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Kelly Chessie
- Santa Maria Senior Citizens Home, Regina, SK, Canada
| | - Alec Couros
- Faculty of Education, University of Regina, Regina, SK, Canada
| | | | | | - Lilian Thorpe
- Department of Community and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jaime Williams
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | | | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
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11
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Zhu CW, Grossman HT, Elder GA, Rosen H, Sano M. Apathy in Lewy body disease and its effects on functional impairment over time. Front Neurol 2024; 15:1339190. [PMID: 38313558 PMCID: PMC10835801 DOI: 10.3389/fneur.2024.1339190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
Background and objectives Apathy strongly affects function in Alzheimer's disease and frontotemporal dementia, however its effect on function in Lewy Body Disease (LBD) has not been well-described. This study aims to (1) examine the prevalence and persistence of apathy in a large, national cohort of well-characterized patients with LBD, and (2) estimate the effect of apathy on function over time. Methods Study included 676 participants with mild cognitive impairment (MCI) or dementia in the National Alzheimer's Coordinating Center Uniform Data Set. Participants were followed for an average of 3.4 ± 1.7 years and consistently had a primary diagnosis of LBD. Apathy was defined by clinician judgment, categorized into four mutually exclusive profiles: (1) never apathetic across all visits, (2) at least one but <50% of visits with apathy (intermittent apathy), (3) ≥50% but not all visits with apathy (persistent apathy), and (4) always apathy across all visits. Dementia severity was measured by baseline Clinical Dementia Rating score. Parkinsonism was defined by the presence of bradykinesia, resting tremor, rigidity, gait, and postural instability. Functional impairment was assessed using the Functional Assessment Questionnaire (FAQ). Results Baseline characteristics of the sample were: average age = 72.9 ± 6.9, years of education = 15.6 ± 3.4, Mini Mental State Exam (MMSE) = 24.4 ± 5.4, Geriatric Depression Scale (GDS) = 3.8 ± 3.2, FAQ = 12.0 ± 9.1. 78.8% were male and 89% were non-Hispanic white. Prevalence of apathy increased from 54.4% at baseline to 65.5% in year 4. 77% of participants had apathy at some point during follow-up. Independent of cognitive status and parkinsonian features, FAQ was significantly higher in participants with intermittent/persistent and always apathetic than never apathetic. Annual rate of decline in FAQ was faster in participants who were always apathetic than never apathy. Discussion In this large national longitudinal cohort of LBD patients with cognitive impairment, apathy was strongly associated with greater functional impairment at baseline and faster rate of decline over time. The magnitude of these effects were clinically important and were observed beyond the effects on function from participants' cognitive status and parkinsonism, highlighting the importance of specifically assessing for apathy in LBD.
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Affiliation(s)
- Carolyn W. Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hillel T. Grossman
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A. Elder
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Howie Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mary Sano
- James J. Peters VA Medical Center, Bronx, NY, United States
- Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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12
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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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Carcavilla-González N, Escalada San Adrián G, Minobes-Molina E, Pàmies-Tejedor S, Roncal-Belzunce V, Atarés-Rodríguez L, García-Navarro JA. A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review. J Alzheimers Dis 2024; 99:829-841. [PMID: 38759003 DOI: 10.3233/jad-231180] [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: 05/19/2024]
Abstract
This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
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Affiliation(s)
- Nuria Carcavilla-González
- Department of Health Sciences, Public University of Navarra, Campus de Arrosadia, Pamplona, Spain
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
| | | | - Eduard Minobes-Molina
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Victoria, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Victoria, Spain
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14
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Olavarría L, Caramelli P, Lema J, de Andrade CB, Pinto A, Azevedo LVDS, Thumala D, Vieira MCS, Rossetti AP, Generoso AB, Carmona KC, Sepúlveda-Loyola W, Pinto LAC, Barbosa MT, Slachevsky A. Impact of the Pandemic Time on the Mental Health of People with Dementia and Their Family Caregivers in Brazil and Chile: One-Year Follow-Up. J Alzheimers Dis 2024; 98:691-698. [PMID: 38427488 PMCID: PMC11175387 DOI: 10.3233/jad-231310] [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] [Indexed: 03/03/2024]
Abstract
Background Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.
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Affiliation(s)
- Loreto Olavarría
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Psychiatry Department, Faculty of Medicine, Universidad de Chile
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - José Lema
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
| | - Caíssa Bezerra de Andrade
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Alejandra Pinto
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Lílian Viana dos Santos Azevedo
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Daniela Thumala
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Faculty of Social Sciences, University of Chile
| | | | | | - Alana Barroso Generoso
- Geriatric Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Karoline Carvalho Carmona
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | | | | | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
- Geriatric Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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15
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García-Martín V, de Hoyos-Alonso MC, Delgado-Puebla R, Ariza-Cardiel G, Del Cura-González I. Burden in caregivers of primary care patients with dementia: influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr 2023; 23:525. [PMID: 37644410 PMCID: PMC10463529 DOI: 10.1186/s12877-023-04234-0] [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: 04/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caregiver burden is related to personal factors and patient characteristics and is greater when neuropsychiatric symptoms (NPSs) are present. OBJECTIVE Estimate the prevalence of burden among caregivers of dementia patients and its association with NPSs and identify NPSs causing greater caregiver distress according to dementia stage. METHODS A cross-sectional observational study in caregivers of noninstitutionalized dementia patients was conducted. Caregiver variables were sociodemographic, time of care, NPS-associated distress based on the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D) and burden based on the Zarit Burden Interview (ZBI). Patient variables were time since disease onset, Global Deterioration Scale (GDS) disease stage, functional assessment and NPS presence and intensity according to the Neuropsychiatric Inventory (NPI). The mean ZBI score, prevalence of burden and NPI-D score with 95% CIs at each dementia stage were estimated. Factors associated with burden were identified by multivariate analysis. RESULTS Of the 125 caregivers included, 77.6% were women, with a mean age of 60.7 (± 14.3) years; 78.4% (95%CI: 71.0; 86.0) experienced burden. The mean ZBI score was 12.3 (95%CI: 11.6; 12.9) and increased according to NPS number (p = 0.042). The NPSs causing the most burden were disinhibition (93.5%), irritability (87.3%) and agitation (86.1%). Agitation, apathy, and sleep disorders were the NPSs generating the greatest overall caregiver distress; depression (max NPI-D 1.9), hyperactivity (max NPI-D 2.1), and psychosis symptoms (max NPI-D 1.6) generated the greatest distress at stage GDS 3, stages GDS 4-5, and stages GDS 6-7, respectively. The NPI score (OR = 1.0, 95%CI 1.0; 1.1), intensity of irritability (OR = 1.2, 95%CI 1.0; 1.6), disinhibition (OR = 2.6, 95%CI 1.1; 5.8) and hyperactivity subsyndrome (OR = 1.1, 95%CI 1.0; 1.2) were associated with caregiver burden. Other associated factors were female gender (OR = 6.0, 95%CI 1.6; 22.8), ≥ 8 h daily care (OR = 5.6, 95%CI 1.4; 22.8), working outside the home (OR = 7.6, 95%CI 1.8; 31.8), living with the patient (OR = 4.5, 95%CI 1.1; 19.6), kinship (OR = 5.4, 95%CI 1.0; 28.2) and lower patient education (OR = 8.3, 95%CI 2.3; 30.3). CONCLUSIONS The burden on caregivers of dementia patients is high and associated with NPS presence and intensity. Disinhibition and irritability caused the highest burden. Depression, hyperactivity and psychosis produce more distress in mild, mild-moderate and severe dementia, respectively.
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Affiliation(s)
- Victoria García-Martín
- Epidemiology and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Madrid, Spain.
| | - M Canto de Hoyos-Alonso
- Pedro Laín Entralgo Health Care Center, Primary Care Management, Madrid Health Service, Alcorcón, Madrid, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
| | - Rosalía Delgado-Puebla
- Primary Care Management, Horta Health Care Center, Catalonia Health Service, Barcelona, Catalonia, Spain
| | - Gloria Ariza-Cardiel
- Family and Community Medicine Teaching Unit Oeste, Primary Care Management, Madrid Health Service, Móstoles, Madrid, Spain
| | - Isabel Del Cura-González
- Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), Madrid, Spain
- Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos (Rey Juan Carlos University), Alcorcón, Madrid, Spain
- Ageing Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Instituto Investigación Sanitaria Gregorio Marañón IiSGM, Madrid, Spain
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Phillips R, Durkin M, Engward H, Cable G, Iancu M. The impact of caring for family members with mental illnesses on the caregiver: a scoping review. Health Promot Int 2023; 38:daac049. [PMID: 35472137 PMCID: PMC10269136 DOI: 10.1093/heapro/daac049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.
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Affiliation(s)
- Rita Phillips
- Robert Gordon University, Garthdee House, Garthdee Road, Aberdeen AB10 7QB, UK
| | | | - Hilary Engward
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Graham Cable
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Maria Iancu
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
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17
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Lee SC, Chien TH, Chu CP, Lee Y, Chiu EC. Practice effect and test-retest reliability of the Wechsler Memory Scale-Fourth Edition in people with dementia. BMC Geriatr 2023; 23:209. [PMID: 37003982 PMCID: PMC10067173 DOI: 10.1186/s12877-023-03913-2] [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: 07/01/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The Wechsler Memory Scale-Fourth Edition (WMS-IV) has been widely used to assess memory function in people with dementia. The older adult battery of the WMS-IV includes four indices and seven subtests. The aims of this study were to examine the practice effect and test-retest reliability and calculate the reliable change index modified for practice (RCIp) for the indices and subtests of the older adult battery of the WMS-IV for people with dementia. METHODS Fifty-six participants completed the WMS-IV twice, two weeks apart. The practice effect was investigated using effect size (Cohen's d) and bootstrapping mixed design analysis of variance while considering the severity of dementia. The test-retest reliability was estimated using intraclass correlation coefficient (ICC). RESULTS The results showed non-significant practice effects with Cohen's d < 0.20 in different severities of dementia on two indices and five subtests. The ICC values of these indices and subtests were 0.82-0.85 and 0.57-1.00, respectively. The other two indices (i.e., auditory memory and immediate memory) and two subtests (i.e., logical memory delayed recall and visual reproduction immediate recall) demonstrated small to moderate practice effect (d = 0.46-0.74) for people with mild severity of dementia. CONCLUSION On the whole, the WMS-IV has no to moderate practice effects and moderate to excellent test-retest reliability in people with dementia. The values of the RCIp with 95% confidence interval for the indices and subtests were provided in this study, which are useful to clinicians and researchers for interpreting the real score change in persons with dementia. The two indices (i.e., auditory memory and immediate memory) and two subtests (i.e., logical memory delayed recall and visual reproduction immediate recall) with noticeable practice effect should be used with caution when assessing memory function repeatedly in people with mild severity of dementia.
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Affiliation(s)
- Shu-Chun Lee
- Department of Occupational Therapy, Taipei City Hospital, Songde Branch, Taipei, Taiwan
- Department of Recreation and Sports Management, University of Taipei, Taipei, Taiwan
| | | | - Chih-Pang Chu
- Division of Psychosomatic Medicine, Taipei City Hospital, Songde Branch, Taipei, Taiwan
| | - Yen Lee
- School of Education, Edgewood College, Madison, WI, USA
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Road, Beitou District, Taipei, 112303, Taiwan.
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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Hamilton G, Azuma T, Lowes S, Gallagher M, Volk K. Supportive Care for Dementia: A Replicable Model to Reduce Neurobehavioral Symptoms, Caregiver Stress, and Hospitalizations, and Increase Hospice Referrals. J Palliat Med 2023; 26:697-699. [PMID: 36745388 DOI: 10.1089/jpm.2022.0534] [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: 02/07/2023] Open
Abstract
Objective: This report describes a hospice-supported no-fee program to support patients living with all levels of dementia and their caregivers. Background: Our medical system struggles to serve the rapidly increasing numbers of patients with dementia. Hospice of the Valley developed a low-cost six-month program to reduce caregiver stress and reduce neurobehavioral disturbances of patients living with dementia, reduce costs for insurers, and increase hospice referrals. Methods: Data were analyzed from 532 patients living with caregivers admitted over 22 months. Caregiver burden, behaviors, hospitalization, and hospice admissions were tracked. Results: Severity of neurobehavioral disturbances and burden to caregivers decreased significantly. Hospitalizations decreased during and after the program, resulting in cost savings for insurance programs. Twenty-five percent of participants were admitted to hospice. Discussion: The Supportive Care for Dementia program was welcomed by community physicians, leading to improved supportive care and increased hospice referrals. The program is replicable and has been adopted by one health plan and is being evaluated by others.
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Affiliation(s)
- Gillian Hamilton
- Hospice of the Valley, Dementia Care and Education Campus, Phoenix, Arizona, USA
| | - Tamiko Azuma
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Susan Lowes
- Teachers College, Columbia University, New York, New York, USA
| | - Maribeth Gallagher
- Hospice of the Valley, Dementia Care and Education Campus, Phoenix, Arizona, USA
| | - Kylee Volk
- Hospice of the Valley, Dementia Care and Education Campus, Phoenix, Arizona, USA
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Domínguez-Vergara J, Santa-Cruz-Espinoza H, Chávez-Ventura G. Zarit Caregiver Burden Interview: Psychometric Properties in Family Caregivers of People with Intellectual Disabilities. Eur J Investig Health Psychol Educ 2023; 13:391-402. [PMID: 36826213 PMCID: PMC9954955 DOI: 10.3390/ejihpe13020029] [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] [Received: 12/04/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Caregivers of people with intellectual disabilities may feel overburdened in their work and experience negative psychological consequences. The purpose of this instrumental study was to determine the evidence of internal structure and reliability of the Zarit Caregiver Burden Interview scale. A total of 398 family caregivers, including women and men, participated (M = 47.33, SD = 10.44). The structure of the scale was evaluated by factor analysis and the McDonald Omega coefficient was used to estimate reliability. Sixteen models of the scale were tested, differing in number of items and factor structures. A model of 15 items and 4 dimensions (overload, competence, social relationship, and interpersonal relationship) obtained acceptable fit (χ2 = 184.72; p < 0.001; CFI = 0.95; TLI = 0.94; RMSEA = 0.055; SRMR = 0.05) and reliability coefficients above 0.70 in their dimensions. It is concluded that the Zarit scale is valid and reliable for use in caregivers of people with intellectual disabilities.
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Affiliation(s)
| | | | - Gina Chávez-Ventura
- Institute for Research in Science and Technology, Universidad César Vallejo, Trujillo 13009, Peru
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21
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Wang F, Nguyen AW. Correlates of Physical and Emotional Strain Among Older Adult Caregivers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:221-238. [PMID: 35791671 PMCID: PMC9816348 DOI: 10.1080/01634372.2022.2097755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Caregiving can be physically challenging and emotionally draining for older caregivers. The existing research on physical and emotional strain mainly focuses on the general caregiver population. Using the Stress Process Model, this study aims to expand on existing caregiving literature by identifying correlates of physical and emotional strain among older caregivers. Hierarchical OLS regressions were performed on data selected from the 2015 Caregiving in the U.S. Survey (N = 701). Several risk factors for physical strain and emotional strain were identified: Assistance with ADLs and IADLs, the number of health problems of the care recipient, and the receipt of formal support were positively associated with physical and emotional strain. Moreover, providing care to parents/parents-in-law was associated with higher levels of emotional strain than providing care to non-relatives. The number of care recipients was positively associated with emotional strain. Older African Americans experienced lower levels of physical strain than their white counterparts. The findings uncover the individual differences among older caregivers and provide insights into how these differences uniquely influence caregiving strain. Moreover, the study identifies a risk and protective profile of caregiving strain, which can help practitioners direct services and resources to older caregivers who are particularly at risk for caregiving strain.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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22
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Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study. Eur J Oncol Nurs 2023; 62:102264. [PMID: 36610289 DOI: 10.1016/j.ejon.2022.102264] [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: 05/09/2022] [Revised: 11/29/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet. METHODS This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet. RESULTS Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving. CONCLUSION The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.
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23
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Akada K, Koyama N, Miura Y, Takahashi K, Aoshima K. Nationwide Database Analysis of Risk Factors Associated with Decreased Activities of Daily Living in Patients with Alzheimer's Disease. J Alzheimers Dis 2023; 94:1465-1475. [PMID: 37393499 DOI: 10.3233/jad-230106] [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: 07/03/2023]
Abstract
BACKGROUND Preserving activities of daily living (ADL) is the key issue for Alzheimer's disease (AD) patients and their caregivers. OBJECTIVE To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years). METHODS Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL. RESULTS A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain. CONCLUSION AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.
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Affiliation(s)
- Keishi Akada
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Tokyo, Japan
| | - Noriyuki Koyama
- Government Relations Strategy Department, Eisai Co. Ltd., Tokyo, Japan
| | - Yuji Miura
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Tokyo, Japan
| | - Kentaro Takahashi
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
| | - Ken Aoshima
- Microbes & Host Defense Domain, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
- School of Integrative and Global Majors, University of Tsukuba, Ibaraki, Japan
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24
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Steffens DC, Fahed M, Manning KJ, Wang L. The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research. Transl Psychiatry 2022; 12:525. [PMID: 36572691 PMCID: PMC9792580 DOI: 10.1038/s41398-022-02292-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in the context of a variety of neuropsychiatric disorders and is related to poor health outcomes. Presence of apathy is associated with cognitive and functional decline in dementia. Despite its negative impact on health, there is no definitive treatment for apathy, a clinical reality that may be due in part to lack of knowledge about assessment, neuropsychological features and neurobiological underpinnings. Here, we review and synthesize evidence from clinical, epidemiological, neuropsychological, peripheral biomarker and neuroimaging research. Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function. Neuropsychological and neuroimaging studies point to dysfunction of brain circuitry involving the prefrontal cortex, especially the dorsolateral prefrontal cortex circuit, the dorsomedial prefrontal cortex circuit, and the ventromedial prefrontal cortex circuit. However, inconsistent findings, particularly in neuroimaging may be due to heterogeneity of apathy symptoms (with a need to better elucidate subtypes), neuropsychiatric comorbidities, the severity of cognitive impairment and other factors. These factors need to be accounted for in future studies so that biomarker research can make progress. On the whole, the literature on apathy has identified likely neurocognitive, peripheral biomarker and neuroimaging targets for understanding apathy, but also points to the need to address methodological issues that will better inform future studies. In turn, as we learn more about the underpinning of apathy and its subtypes, subsequent research can focus on new neurally based interventions that will strengthen the clinical management of apathy in the context of its comorbidities.
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Affiliation(s)
- David C. Steffens
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Mario Fahed
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Kevin J. Manning
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Lihong Wang
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
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25
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Factors associated with positive aspects of caregiving experiences among family caregivers of persons living with dementia in Taiwan: A cross-sectional study. Geriatr Nurs 2022; 48:229-236. [PMID: 36283147 DOI: 10.1016/j.gerinurse.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022]
Abstract
This study examined the associated factors of positive aspects of caregiving experience among family caregivers of persons living with dementia in Taiwan. This cross-sectional correlational study recruited dyads of primary family caregivers of persons living with dementia by convenience sampling from dementia care centers in northern Taiwan from September 9, 2020, to June 20, 2021. A total of 100 dyads who met inclusions criteria agreed to participate in the study. Significant predictors of positive aspects of caregiving experience were scores of dementia behavior disturbance (t=-3.63, p =<.001), a spousal caregiver (t=2.83, p =.006), and the subscale score for satisfaction on the functional social support (t=2.62, p =.01). Our findings suggest prevention and treatment of dementia behavior disturbance for persons living with dementia, improving satisfaction with functional social support, and focusing on non-spousal caregivers could enhance experiences of positive caregiving for family caregivers.
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26
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Radu M, Ciucă A, Crișan CA, Pintea S, Predescu E, Șipos R, Moldovan R, Băban A. The impact of psychiatric disorders on caregivers: An integrative predictive model of burden, stigma, and well-being. Perspect Psychiatr Care 2022; 58:2372-2382. [PMID: 35347717 PMCID: PMC9790354 DOI: 10.1111/ppc.13071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The study investigates the predictors of caregivers' experienced burden, stigma, and well-being, when looking after family members diagnosed with a psychiatric disorder. DESIGN AND METHODS This cross-sectional study included 168 caregivers; perceived burden, stigma, well-being, knowledge, illness perception, and medical variables were assessed. FINDINGS A number of correlates of burden, stigma, and well-being have been identified and are being discussed. The integrative predictive model showed that the caregiver's emotional representation of illness best predicts burden (β = 0.38, p < 0.001), stigma (β = 0.53, p < 0.001) and well-being (β = -0.36, p < 0.001). PRACTICE IMPLICATIONS Our results can enable health professionals to tailor psychosocial interventions addressed to family members of individuals living with a psychiatric condition.
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Affiliation(s)
- Mădălina Radu
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Andrada Ciucă
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Cătălina-Angela Crișan
- Department of Neurosciences, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Elena Predescu
- Department of Neuroscience, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Șipos
- Department of Neuroscience, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona Moldovan
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Adriana Băban
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
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27
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Patrick KS, Gunstad J, Martin JT, Chapman KR, Drost J, Spitznagel MB. Specific agitation behaviours in dementia differentially contribute to aspects of caregiver burden. Psychogeriatrics 2022; 22:688-698. [PMID: 35853570 PMCID: PMC9544824 DOI: 10.1111/psyg.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Agitation is a common symptom in dementia and linked to caregiver burden, but both agitation and burden are multidimensional constructs. The current study sought to determine whether specific presentations of agitation differentially relate to aspects of caregiver burden. METHODS Medical record data from an outpatient memory clinic were extracted for 609 persons with dementia, including caregiver-reported burden and care recipient agitation. RESULTS Exploratory factor analysis yielded three domains of agitation on the Cohen Mansfield Agitation Inventory ('Physically Aggressive', 'Physically Non-Aggressive', 'Verbally Agitated') and four domains of burden on the Zarit Burden Interview ('Impact on Life', 'Guilt/Uncertainty', 'Embarrassment/Frustration', 'Overwhelm'). Regression analyses demonstrated all domains of agitation positively predicted overall burden. Regarding specific aspects of burden, Physically Aggressive behaviours predicted Embarrassment/Frustration. Physically Non-Aggressive behaviours predicted Impact on Life and Guilt/Uncertainty. Verbally Agitated behaviours predicted all burden dimensions. CONCLUSIONS Results suggest specific aspects of agitation may differentially contribute to facets of caregiver burden.
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Affiliation(s)
- Karlee S Patrick
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - John T Martin
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Kimberly R Chapman
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jennifer Drost
- Summa Health System Department of Geriatrics, Akron, Ohio, USA
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28
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Kim J, Lee J, Park J, Kim H, Yoo I. The Impact of Physical Environment on the Cognitive Function of the Elderly: A Scoping Review of Cohort Studies. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211058826] [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 review examined whether the physical environment can change the cognitive function of the elderly and categorized the specific environmental types. Four databases, CINAHL, Embase, PubMed, and PsycINFO, were searched for relevant literature published as of December 2020. The framework used was proposed by Arksey and O’Malley, which includes a 5-stage review process. A total of 12 studies were examined. The physical environments with similar characteristics, among all the environmental elements, were grouped together into 4 categories: residential density and road connectivity, limited living space, urban/rural, and care facilities. Residential density and road connectivity, limited living space, and care facilities were found to have a significant effect on the cognitive function of the elderly. However, there was no significant effect on the cognitive function of the elderly when comparing the urban and rural environments. Although studies on environments that affect the cognitive function of the elderly are still ongoing, the ones analyzing specific environments in detail are insufficient. With the increasing importance of the role played by the environment in the cognitive impairment of the elderly, detailed studies on specific environments among the various environmental factors surrounding the elderly, such as this study, should be conducted more actively.
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Affiliation(s)
- Jihye Kim
- Jeonju University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Jiyeong Lee
- Jeonju University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Jihye Park
- Jeonju University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Hakseong Kim
- Jeonju University, Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Ingyu Yoo
- Jeonju University, Jeonju-si, Jeollabuk-do, Republic of Korea
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29
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Iravani B, Abdollahi E, Eslamdoust-Siahestalkhi F, Soleimani R. Neuropsychiatric Symptoms of Alzheimer's Disease and Caregiver Burden. Front Neurol 2022; 13:877143. [PMID: 35968317 PMCID: PMC9372403 DOI: 10.3389/fneur.2022.877143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction/Objectives In addition to cognitive decline, one of the most important problems for caregivers of patients with Alzheimer's is neuropsychiatric symptoms (NPS). This study aimed to evaluate the NPS in patients with Alzheimer's disease (AD) and investigate its relationship with caregiver burden (CB). Methods In a cross-sectional study of 85 patients with AD referred to Shafa Hospital in Rasht and their caregivers in 2020, information was collected using a demographic questionnaire, Neuropsychiatric Inventory Questionnaire (NPI-Q), and the Caregiver Burden Inventory (CBI). Data were analyzed by Spearman correlation, t-test, and linear regression, with SPSS version 22. Results The mean age of the patients and their caregivers were 74.95 ± 8.87 years and 43.98 ± 11.38 years, respectively. The mean total score of NPS in patients with AD was 44.25 (0–144) and the mean CB score was 36.27 (0–96), which was a moderate level. According to the results, 91% of patients had apathy, while happiness/euphoria was reported as the most uncommon symptom. In addition, there was a significant relationship between the score of NPS and CB (r = 0.542, P < 0.0001), as well as all its sub-components, time-dependence burden with more correlation (r = 0.509, P < 0.0001), and social burden with less correlation (r = 0.352, P < 0.001). NPS, hallucination, aberrant motor behavior (AMB), delusion, and depression were most correlated with CB. Also, the mean score of CB was significantly higher in women than in men (P = 0.045). Living in a rural area had a significant relationship with NPS score (P = 0.026). Also, linear regression showed that with increasing 1 year of patients' age, the mean score of patient's NPS decreased by 0.374 (P = 0.048). Conclusion Neuropsychiatric symptoms, especially hallucination, aberrant motor behavior (AMB), delusion, and depression were associated with caregiver burden. Apathy was the most common symptom in patients with AD.
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Romero DE, Maia LR, Muzy J, Andrade N, Szwarcwald CL, Groisman D, Souza Júnior PRBD. [Homecare of elderly Brazilians with functional dependency: inequalities and challenges during the first wave of the COVID-19 pandemic]. CAD SAUDE PUBLICA 2022; 38:e00216821. [PMID: 35584434 DOI: 10.1590/0102-311x00216821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
Abstract
The article aims to analyze the pandemic's effect on the burden of care for elderly persons with functional dependency according to the presence of hired caregivers and socioeconomic conditions in the year 2020. Data were obtained from the ConVid - Behavior Survey of 2020. We calculated the percentage distribution and prevalence of the population living with elderly persons with functional dependency during the COVID-19 pandemic according to sex, race/color, and income. We estimated the Pearson chi-square test and prevalence ratio for the increase in household work, fitting Poisson regression models with robust variance and using 95% confidence intervals (95%CI). Among adults living with elderly individuals, 8.1% (95%CI: 7.1-9.4) had at least one elderly person with functional dependency. During the pandemic, 11.7% (95%CI: 8.5-16.0) stopped hiring third-party caregivers, which can be explained by social distancing to reduce risk of transmission and/or by the decline in families' purchasing power. Those who lost hired caregivers during the pandemic were more likely to experience an increase in the burden of care, regardless of their socioeconomic status. There was an unequal distribution of caregiving work in the population, intensified by the arrival of the COVID-19 pandemic. The heavier load of care for elderly persons with functional dependency was sharper in more socioeconomically privileged groups such as whites and those with higher income. One hypothesis is that more vulnerable groups already bore a high burden of care before the pandemic. The crisis in care has been aggravated by the dismantling of primary healthcare in Brazil, a reduction in social support for Brazilian families during the pandemic, and rising unemployment, decreasing families' capacity to hire caregivers.
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Affiliation(s)
- Dalia Elena Romero
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Leo Ramos Maia
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Jéssica Muzy
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Nathália Andrade
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Celia Landmann Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Daniel Groisman
- Escola Politécnica de Saúde Joaquim Venâncio, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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The Impact of COVID-19 on the Health and Experience of the Carers of Older Family Members Living with Dementia: An Italian-Hungarian Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095329. [PMID: 35564723 PMCID: PMC9104228 DOI: 10.3390/ijerph19095329] [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: 03/11/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/04/2023]
Abstract
This quantitative study (n = 370) compares the pandemic-related experiences of the family carers of older people living with dementia during the first wave of the pandemic, in two countries with different care regimes: Italy (Mediterranean) and Hungary (Eastern European). It aims at answering the following research questions: (1) How did the pandemic affect the subjective health of carers, and what were their experiences with care-related worries and workload? (2) What factors significantly predicted negative changes in these experiences? (3) What were carers' main difficulties during the first pandemic wave? Results have shown that carers in both samples reported a worsening in mental health (Italy/Hungary: M = 2.25/2.55, SD = 0.93/0.99), and Italian carers also in general health (M = 2.54, SD = 0.98) (on a scale of 1 to 5, with values under "3" representing deterioration). Carers in both samples experienced high worry levels (Italy/Hungary: M = 4.2/3.7, SD = 0.93/0.89) and feeling overwhelmed with care tasks (M = 3.2/3.7, SD = 1.3/1.3) (on a scale of 1 to 5, higher values representing higher worry/work overload). In regression models, all of the above negative experiences were predicted by a combination of factors. Two of these factors stood out in importance due to being a predictor of more than one type of negative experience: a decline in the carer-care receiver relationship, predicting work overload, as well as general and mental health deterioration and being the child of the care receiver, predicting both high worry and subjective work overload. The top five encountered problems were the unavailability of medical and social care, difficulties with shopping (medicine included), restricted freedom, isolation, and anxiety.
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Hsieh CJ, Yin PF, Chiu CY, Hsiao YP, Hsiao YL. Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research. Healthcare (Basel) 2022; 10:healthcare10030569. [PMID: 35327047 PMCID: PMC8956025 DOI: 10.3390/healthcare10030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. Methods: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. Results: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. Conclusions: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient’s care needs in life. It is a tool that can effectively be used for support and empowerment in this population.
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Affiliation(s)
- Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
- Correspondence: ; Tel.: +886-2-2822-7101-3135; Fax: +886-2-28206729
| | - Pei-Fang Yin
- Department of Long-Term Care, Camillian Saint Mary’s Hospital, Yilan 265502, Taiwan;
| | - Chi-Yi Chiu
- Lezhi Home-Based Long-Term Care Institution, New Taipei City 220043, Taiwan;
| | - Yu-Ping Hsiao
- Yue Xin Day-Care Center for Dementia and Child Development, Assessment and Intervention Center, New Taipei City 242033, Taiwan;
| | - Yu-Ling Hsiao
- Center of Geriatric Care Resource, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
- Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
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Dunn T, Howlett SE, Stanojevic S, Shehzad A, Stanley J, Rockwood K. Patterns of Symptom Tracking by Caregivers and Patients With Dementia and Mild Cognitive Impairment: Cross-sectional Study. J Med Internet Res 2022; 24:e29219. [PMID: 35084341 PMCID: PMC8832273 DOI: 10.2196/29219] [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] [Received: 04/08/2021] [Revised: 08/13/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Individuals with dementia and mild cognitive impairment (MCI) experience a wide variety of symptoms and challenges that trouble them. To address this heterogeneity, numerous standardized tests are used for diagnosis and prognosis. myGoalNav Dementia is a web-based tool that allows individuals with impairments and their caregivers to identify and track outcomes of greatest importance to them, which may be a less arbitrary and more sensitive way of capturing meaningful change. Objective We aim to explore the most frequent and important symptoms and challenges reported by caregivers and people with dementia and MCI and how this varies according to disease severity. Methods This cross-sectional study involved 3909 web-based myGoalNav users (mostly caregivers of people with dementia or MCI) who completed symptom profiles between 2006 and 2019. To make a symptom profile, users selected their most personally meaningful or troublesome dementia-related symptoms to track over time. Users were also asked to rank their chosen symptoms from least to most important, which we called the symptom potency. As the stage of disease for these web-based users was unknown, we applied a supervised staging algorithm, previously trained on clinician-derived data, to classify each profile into 1 of 4 stages: MCI and mild, moderate, and severe dementia. Across these stages, we compared symptom tracking frequency, symptom potency, and the relationship between frequency and potency. Results Applying the staging algorithm to the 3909 user profiles resulted in 917 (23.46%) MCI, 1596 (40.83%) mild dementia, 514 (13.15%) moderate dementia, and 882 (22.56%) severe dementia profiles. We found that the most frequent symptoms in MCI and mild dementia profiles were similar and comprised early hallmarks of dementia (eg, recent memory and language difficulty). As the stage increased to moderate and severe, the most frequent symptoms were characteristic of loss of independent function (eg, incontinence) and behavioral problems (eg, aggression). The most potent symptoms were similar between stages and generally reflected disruptions in everyday life (eg, problems with hobbies or games, travel, and looking after grandchildren). Symptom frequency was negatively correlated with potency at all stages, and the strength of this relationship increased with increasing disease severity. Conclusions Our results emphasize the importance of patient-centricity in MCI and dementia studies and illustrate the valuable real-world evidence that can be collected with digital tools. Here, the most frequent symptoms across the stages reflected our understanding of the typical disease progression. However, the symptoms that were ranked as most personally important by users were generally among the least frequently selected. Through individualization, patient-centered instruments such as myGoalNav can complement standardized measures by capturing these infrequent but potent outcomes.
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Affiliation(s)
| | - Susan E Howlett
- Ardea Outcomes, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sanja Stanojevic
- Ardea Outcomes, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | | | - Kenneth Rockwood
- Ardea Outcomes, Halifax, NS, Canada.,Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada.,Geriatric Medicine Research Unit, Nova Scotia Health Authority, Halifax, NS, Canada
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Huang WC, Chang MC, Wang WF, Jhang KM. A Comparison of Caregiver Burden for Different Types of Dementia: An 18-Month Retrospective Cohort Study. Front Psychol 2022; 12:798315. [PMID: 35111109 PMCID: PMC8801423 DOI: 10.3389/fpsyg.2021.798315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background This study aimed to elucidate the influence of dementia etiologies on the degree of caregiver burden and determine which factors predict a high caregiving burden. Methods This 18-month retrospective cohort study enrolled 630 patients and their caregivers from the Dementia Center of Changhua Christian Hospital. The care team performed face-to-face interviews every 6 months, for 18 months from when a diagnosis of dementia was made. The primary outcome was the change in Zarit Burden Interview (ZBI) scores. Generalized estimating equations were used for the longitudinal data analysis. Results Participants with Lewy body disease (LBD) had a significantly higher caregiving burden compared with those with Alzheimer's disease (AD) (β = 3.83 ± 1.47, Wald = 6.79, p = 0.009) after adjusting for patient and caregiver features. Caregivers of mixed-type dementia and frontotemporal dementia (FTD) experienced a greater burden than caregivers of AD, at 6- and 18-month follow-up. Patients with more severe dementia, neuropsychiatric symptoms, being cared for by more than two caregivers, or utilizing social resources were associated with higher ZBI scores; the depressive mood of caregiver also predicted higher ZBI scores. Conclusion This longitudinal study demonstrated that caregiver burden was influenced by the underlying dementia etiology of patients. The dementia care team should provide personalized education and transfer patients and caregivers to appropriate resources, especially for high-risk populations.
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Affiliation(s)
- Wen-Chien Huang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Recreation and Holistic Wellness, Ming Dao University, Changhua, Taiwan
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
- *Correspondence: Kai-Ming Jhang
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Wang L, Zhou Y, Fang X, Qu G. Care burden on family caregivers of patients with dementia and affecting factors in China: A systematic review. Front Psychiatry 2022; 13:1004552. [PMID: 36545040 PMCID: PMC9760850 DOI: 10.3389/fpsyt.2022.1004552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia is a chronic and progressive illness characterized by severe impairment and high dependencies. Under the influence of Chinese traditional culture, 80% of patients with dementia are watched over at home by family caregivers as primary caregivers. However, long-term care brings formidable burdens to them and reduces the quality of their life. It is necessary to find out the influencing factors of caregivers' burden. METHODS A scoping search was conducted on eight electronic databases from 1 January 2010 to 14 June 2022: PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, China VIP Database, China Biomedical Literature Database, and Wanfang Data Knowledge Service Platform. Research articles included in this review discussed the factors affecting Chinese dementia family caregivers' care burden or stress, and the level of care burden was evaluated by a standardized care burden scale. RESULTS A total of 1,888 related articles were found and 23 cross-sectional studies were eventually included. After quality assessment, 12 were of good quality and 11 were of fair quality. A total of 32 factors were identified that were associated with caregiver burden, and the results were grouped into three categories: patient, caregiver, and society. The severity of disease, poor self-care ability, neuropsychiatric symptoms, care time, number of helpers, poor health status, economic stress, poor psychological status, social support, and age were reported in many previous studies. CONCLUSION In this review, the factors that affect the caregiver burden for people with dementia were clarified. By identifying these factors, hospitals, decision-makers, and communities can carry out special projects for these populations, provide appropriate assistance, or design corresponding intervention measures to reduce the caregiver burden and improve the quality of care for patients with dementia. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022347816].
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Affiliation(s)
- Lan Wang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yang Zhou
- School of Nursing, Weifang Medical University, Weifang, China
| | | | - Guiyu Qu
- School of Nursing, Weifang Medical University, Weifang, China
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Franzen S, Eikelboom WS, van den Berg E, Jiskoot LC, van Hemmen J, Papma JM. Caregiver Burden in a Culturally Diverse Memory Clinic Population: The Caregiver Strain Index-Expanded. Dement Geriatr Cogn Disord 2021; 50:333-340. [PMID: 34700324 DOI: 10.1159/000519617] [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: 08/03/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although qualitative studies have highlighted substantial barriers to dementia diagnosis and care in culturally diverse populations in Europe, quantitative studies examining the level of caregiver burden in these populations have been lacking thus far and are urgently needed. METHODS We compared the caregiver burden levels on the Caregiver Strain Index (CSI)-Expanded of 63 culturally diverse patient-caregiver dyads from a multicultural memory clinic with 30 native Dutch patient-caregiver dyads and examined the association between caregiver burden and determinants of burden. RESULTS Informal caregivers in the multicultural memory clinic cohort experienced a high level of caregiver burden (mean CSI-score multicultural cohort: 6.1 [SD: 3.3]; mean CSI-score native Dutch cohort: 4.8 [SD: 3.2]). Burden was significantly associated with impairment on proxy-rated and objective measures of cognitive functioning, such as the Informant Questionnaire on Cognitive Decline and the Rowland Universal Dementia Assessment Scale, and with instrumental activities of daily living. Burden was the highest in spousal caregivers. The positive subscale of the CSI-Expanded provided limited additional information. CONCLUSION Caregivers of culturally diverse patients experience a high level of caregiver burden, in particular at more advanced disease stages. This study highlights the need to screen culturally diverse caregivers in European memory clinics on caregiver burden to identify those in need of caregiver support.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem S Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Abstract
Diabetes is one of the most common disease states in older adults and there are significant risks to the use of antidiabetic medications. The older adult population varies greatly in functional ability, independence, and cognition. These factors, along with increased risk of hypoglycemia, falls, and other comorbidities, add to the complexity of creating medication regimens to treat diabetes in older adults. In the current review, a person-centered approach to diabetes care in older adults is described to aid clinician decision making. By keeping the patient and their individual factors in the center of the decision, risks of over- or under-treating diabetes can be minimized. The review will discuss person-centered goal setting, practical approaches to diabetes medication management, and specific considerations for choosing medication classes based on patient characteristics. [Journal of Gerontological Nursing, 47(10), 7-13.].
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Caregiver strain in progressive supranuclear palsy and corticobasal syndromes. J Neural Transm (Vienna) 2021; 128:1611-1621. [PMID: 34296340 PMCID: PMC8528777 DOI: 10.1007/s00702-021-02379-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) progress relentlessly and lead to a need for care. Caregiving is often burdensome. Little is known about the course of caregiver burden (CB) in PSP and CBS patients. Longitudinal analysis of CB in family members caring for PSP and CBS patients. Single-center longitudinal pilot study in 68 newly diagnosed patients with probable PSP and CBS (52 Richardson’s syndrome; 1 progressive gait freezing of PSP; 15 CBS). Demographic, educational, occupational parameters, family status, motor functions (UPDRSIII, Hoehn and Yahr Score, Tinetti) and neuropsychological performance (CERAD Plus, Frontal Assessment Battery) were assessed, as well as behavioral and neuropsychiatric impairments (Frontal Behavioral Inventory, Neuropsychiatric Inventory), activities of daily living (ADL) and caregiver burden using the Caregiver Strain Index (CSI), in most patients also the Zarit Burden Interview (ZBI). Patients were followed up every 6 months for up to 2 years. Caregivers reported mild to moderate CB at baseline, which increased by 25–30% in 2 years and was significantly greater in PSP than in CBS. Risk for mental health problems increased over time, especially in female caregivers (depression). Important patient-related factors were apathy, aspontaneity, depression, irritability, disorganization, poor judgment, impairment of language, impairments in ADL, a high educational level of the patient and close family relationship. Behavioral symptoms and impaired ADL are the main patient-related factors of CB in PSP and CBS. CB can be severe and needs to be assessed repeatedly from the time of diagnosis to provide comprehensive support.
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Russell AM, Saketkoo LA. Patient-Centredness and Patient-Reported Measures (PRMs) in Palliation of Lung Disease. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kanemoto H, Sato S, Satake Y, Koizumi F, Taomoto D, Kanda A, Wada T, Yoshiyama K, Ikeda M. Impact of Behavioral and Psychological Symptoms on Caregiver Burden in Patients With Dementia With Lewy Bodies. Front Psychiatry 2021; 12:753864. [PMID: 34777057 PMCID: PMC8578553 DOI: 10.3389/fpsyt.2021.753864] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background/Objective: Behavioral and psychological symptoms of dementia (BPSD) have been reported to affect caregiver burden in patients with dementia with Lewy bodies (DLB). However, the factor structure of BPSD and the factors that affect caregiver burden in DLB remain unknown. This study sought to classify BPSD and to reveal what type of BPSD affects caregiver burden in patients with DLB. Methods: We collected data on neuropsychiatric inventory-plus (NPI-plus), Zarit Burden Interview (ZBI), Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living and Physical Self-Maintenance Scale (IADL/PSMS), age, and sex of 102 patients with probable DLB. An exploratory factor analysis of 13 items of the NPI-plus was carried out to classify BPSD. Multivariate regression analyses were conducted to extract the clinical variables related to caregiver burden, including factors resulting from the aforementioned factor analysis. Results: The mean age and MMSE score were 78.6 (5.6) and 20.2 (5.2), respectively. Factor analysis revealed four factors of "psychosis," "affection," "wakefulness," and "hyperactivity." "Psychosis" and "affection" factors as well as MMSE, IADL, and PSMS were significantly associated with ZBI. Multivariate regression analyses revealed that the total score of ZBI was associated with "psychosis," "affection," and IADL, that the personal strain score of ZBI was associated with "affection" and IADL, and that the role strain score of ZBI was associated with "wakefulness" and IADL. Conclusions: BPSD in DLB consists of three factors common to Alzheimer's disease and a specific "wakefulness" factor. In addition to IADL, each BPSD factor would affect caregiver burden in different ways in DLB.
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Affiliation(s)
- Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fuyuki Koizumi
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Kanda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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