Factors associated with informal caregiving and its effects on health, work, and social activities of adult informal caregivers in Malaysia: findings from the National Health and Morbidity Survey 2019

Deterioration of health-related quality of life: the hidden health burden of informal caregiving

Informal caregiving is physically and mentally demanding and may lead to poor health and impaired well-being. We aim to check the effects of informal caregiving on health-related quality of life (HRQoL). We utilised longitudinal data from the most recent sixteen waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. We measured HRQoL through the physical component summary (PCS), the mental component summary (MCS), the short-form six-dimension (SF-6D) utility index, and the eight dimensions of the SF-36 health survey. The primary exposure variable is informal caregiving. The variable was categorised into not a caregiver, lighter (< 5 hours [h]/week), moderate (5-19 h/week), and intensive (≥ 20 h/week) caregiving based on the hours of providing informal care per week. We have found that informal caregiving negatively affects HRQoL. We found that moderate (β = -0.0035, standard error [SE] = 0.0012) and intensive caregiving (β = -0.0074, SE = 0.0020) reduced SF-6D utility value. We also found that lighter (β = -0.29, SE = 0.07), moderate (β = -0.55, SE = 0.12), and intensive (β = -1.53, SE = 0.19) caregiving lowered MCS scores. Moreover, our results revealed that lighter, moderate and intensive caregiving decreases the scores of mental health-related dimensions (e.g., role emotional, social functioning, and mental health) of the SF-36 health survey. Our study findings have significant policy implications for improving the HRQoL and well-being of caregivers. To effectively support the health and well-being of informal carers, it is crucial to implement strategies that address their diverse needs, including supporting work-life balance, providing financial assistance and social security measures, ensuring access to community-based services, providing access to relevant information and training, and offering respite care options.

Determinants of Quality of Life in Thai Caregivers of Dependent Older Adults: The Role of Health Promotion and Occupational Risks

Caregiving for dependent older adults presents significant health and occupational challenges, particularly in rural Thailand. This study examines predictors of health-related quality of life (HR-QOL) among in-home caregivers, focusing on health promotion, non-communicable diseases (NCDs) prevention, and occupational health practices. An analytic cross-sectional study was conducted among 701 caregivers across 23 districts in Nakhon Si Thammarat, southern Thailand. Data were collected through structured questionnaires assessing socio-demographics, health behaviors, working conditions, and HR-QOL using the Thai SF-36V2. Stepwise regression analysis identified key predictors of HR-QOL. Our findings indicate that most caregivers were female (81.5%), middle-aged (mean age: 47.7 years), and had moderate education levels. Over half experienced moderate exposure to occupational hazards, including physical, biological, ergonomic, and psychosocial risks, contributing to job strain, inadequate rest, and strained relationships. HR-QOL scores suggested that a significant proportion of caregivers had moderate to poor quality of life, particularly in physical health domains. Stepwise regression analysis showed that better self-reported health promotion behaviors and occupational hazard prevention practices were positively associated with HR-QOL, whereas the presence of NCDs had a negative impact. These findings highlight the need for targeted interventions to enhance caregivers' well-being and inform public health strategies for strengthening community-based care systems.

Supervision programs implemented by nurses to caregivers in community: a scoping review protocol

Introduction

With the increase in the number of informal caregivers, their training becomes essential. The supervisory programs implemented by nurses play a leading role in caregiver training.

Objectives

To map the supervisory programs implemented by nurses to caregivers in the community.

Methods

A scoping review will be developed according to the guidelines of the Joanna Briggs Institute. Studies published and unpublished in English, Portuguese or Spanish since 1993 will be considered. The results of the research, study selection and inclusion process will be presented in a PRISMA flowchart for scoping reviews.

Results

Mapping the evidence will allow us to analyze the supervision programs implemented by nurses for caregivers in the community. The results will be presented through an extraction table according to the objectives.

Conclusion

This review is expected to constitute a starting point for the critical analysis of studies relating to supervisory programs implemented by nurses for caregivers.

Risk Assessment Profiles for Caregiver Burden in Family Caregivers of Persons Living with Alzheimer's Disease: An Exploratory Study with Machine Learning

Alzheimer's disease (AD) places a profound global challenge, driven by its escalating prevalence and the multifaceted strain it places on individuals, families, and societies. Family caregivers (FCs), who are pivotal in supporting family members with AD, frequently endure substantial emotional, physical, and psychological demands. To better understand the determinants of family caregiving strain, this study employed machine learning (ML) to develop predictive models identifying factors that contribute to caregiver burden over time. Participants were evaluated across sociodemographic clinical, psychophysiological, and psychological domains at baseline (T1; N = 130), six months (T2; N = 114), and twelve months (T3; N = 92). Results revealed three distinct risk profiles, with the first focusing on T2 data, highlighting the importance of distress, forgiveness, age, and heart rate variability. The second profile integrated T1 and T2 data, emphasizing additional factors like family stress. The third profile combined T1 and T2 data with sociodemographic and clinical features, underscoring the importance of both assessment moments on distress at T2 and forgiveness at T1 and T2, as well as family stress at T1. By employing computational methods, this research uncovers nuanced patterns in caregiver burden that conventional statistical approaches might overlook. Key drivers include psychological factors (distress, forgiveness), physiological markers (heart rate variability), contextual stressors (familial dynamics, sociodemographic disparities). The insights revealed enable early identification of FCs at higher risk of burden, paving the way for personalized interventions. Such strategies are urgently needed as AD rates rise globally, underscoring the imperative to safeguard both patients and the caregivers who support them.

A Narrative Exploration of Family Members' Perspectives of Life Story Phases Following Transition of an Older Family Relative Into Long-Term Care

BACKGROUND

The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care.

OBJECTIVE

This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care.

METHOD

Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method.

RESULTS

Four key life story phases were identified: before transition, crisis event, transition and after transition. These phases varied in time duration and involvement of healthcare providers. The longest phase was 'before transition' where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period 'crisis event' where the older person was admitted to tertiary care. Two permeating themes: family dynamics and knowledge/understanding underpinned all life story phases.

CONCLUSIONS

Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process.

IMPLICATIONS FOR PRACTICE

Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.

Perceptions of informal caregivers about motivations, needs, and benefits of care for dependent older adults

The informal caregiver provides non-remunerated permanent or regular care to dependent older adults. This qualitative study aimed to identify the perceptions of informal caregivers about motivations, needs, and benefits of caring for dependent older adults. It was conducted with ten Portuguese informal caregivers, based on an instrument with questions about the care provided to older adults and their perceptions about performing this role. The results revealed the following motivations for care: proximity and trust relationship, duty of care, more available family members, home proximity, lack of vacancies, high cost of shelter institutions, and older adults' desire to remain in their homes. The primary care activities for older adults are hydration, hygiene, food, therapeutic administration, companionship, emotional support, comfort, entertainment, and promoting autonomy and dignity. The needs identified by the caregivers were home, social security, and the caregiver's employer support, financial help, psychological support, and training to care for the older adults. The benefits of informal care for dependent older adults were prompt family support, physical and emotional security, affection, and companionship. This study gives voice to crucial citizens.

Informal caregiving among people supporting a person with type 2 diabetes in rural communities of Northern Vietnam: A cross-sectional study of caregiver burdens

OBJECTIVE

The prevalence of type 2 diabetes mellitus (T2DM) in Vietnam has doubled from 3% to 6% over the last decades, with potential consequences for persons with diabetes and their caregivers. This study aimed to assess caregiver burdens and factors associated with caregiver burden.

METHOD

A cross-sectional study was conducted in 2019, using data from 1,241 informal caregivers (ICGs). Caregiver burden was scored from 0-32 using 8 questions from the Zarit Burden Interview (ZBI). Quantile regression analysis was used to identify factors associated with caregiver burden.

RESULTS

The median score of the ZBI was 7.0 (Q1-Q3: 2.0-10.0), indicating that the burden among caregiver of persons with T2DM is not high. Quantile regression showed that the higher the monthly income, the lower the burden among caregivers (50% quantile and 75% quantile of burden: -0.004). Lower educational level (25%Q: 4.0, 50%Q; 3.0, 75%Q: 2.16), being a farmer (25%Q: 2.0) and providing care to other people besides the person with T2DM (25%Q: 2.0, 50%Q; 2.54, 75%Q: 1.66) were associated with higher burden on caregivers.

CONCLUSION

The study found that caregivers facing additional life stressors, such as low income or other caregiving responsibilities, reported higher levels of burden. These findings could inform the development of interventions targeted at supporting informal caregivers in rural areas in low- and middle-income countries.

Impact of a COVID-19-Related Lockdown on the Experience of Informal Caregiving in Singapore

INTRODUCTION

Lockdowns, while limiting COVID-19 transmission, can affect provision of care by informal caregivers and their caregiving experience. We assessed, among informal caregivers in Singapore, (a) the perceived impact of a 2-month (April to May 2020) nationwide lockdown on their care provision, (b) correlates of different perceptions of the impact of the lockdown on care provision, and (c) association of different perceptions of the impact with negative and positive experiences of caregiving.

METHODS

In the August 2020 wave of the Singapore Life Panel (SLP; nationally representative, longitudinal monthly survey of Singapore citizens and permanent residents aged 50-70 years at baseline), 1,094 participants identified as informal caregivers reported whether their care provision became easier, remained the same, or became harder during the lockdown, compared to before the lockdown. We used multinomial logistic regression to assess the association of caregiver, care recipient, and caregiving context characteristics with their perceptions. Linear regression models examined the association of their perceptions with negative and positive experience domains of the modified Caregiver Reaction Assessment.

RESULTS

Just over one-third (36.1%) of the informal caregivers reported that their care provision became harder during the lockdown compared to before the lockdown. However, nearly one-fifth (18.0%) said that it became easier, and the rest (45.9%) said that it remained the same. Care provision was more likely to be perceived as having become harder among caregivers who were male, of Chinese ethnicity, in worse health, whose care recipients had functional limitations, who did not have caregiving support from cohabiting family members before the lockdown, and who had caregiving support from non-cohabiting family members before the lockdown. The perception that care provision became easier was less likely among caregivers who were of higher age, were unemployed, were socially isolated, and whose care recipients had functional limitations. Caregivers who perceived that care provision became harder during the lockdown were worse-off in negative experiences of caregiving.

CONCLUSION

A nationwide lockdown did not make care provision harder for all informal caregivers. However, informal caregivers for whom it did were more likely to have greater negative experiences of caregiving. The heterogeneity of the impact of lockdowns and the possibility of offering flexibility to non-cohabiting family members who support caregiving should be important considerations when planning for such disruptions.

The Unmet Needs of Caregiving Skills, Support, Emotions, and Finances of Stroke Caregivers: A Multicenter Study

​​​​​​Background Informal stroke caregivers in Malaysia play an important role in supporting stroke survivors following acute care. Nevertheless, there is a lack of available data to inform the sufficiency of help and resources available to address the needs of local stroke caregivers. This study aimed to determine the unmet needs in caregiving skills, support, emotions, and finances as well as the associated factors of stroke caregivers in Malaysia. Methodology This multicenter, cross-sectional study used a self-administered survey developed and validated for the Malaysian population. It was prepared in paper-based and web-based formats, and it was distributed via direct contact with the respondents, post, and email. Respondents were recruited from different sites in Malaysia. In this study, unmet needs were defined as "help that was needed more or was not provided to assist caregivers and address their specific needs." This article only presents the quantitative data of this study. Data were analyzed using descriptive analysis and logistic regression to determine factors associated with unmet needs. Results Almost all study respondents (91%) reported having unmet needs. Unmet needs ranged from 1 to 10, while the mean unmet needs was 5. The highest unmet need was related to financial support (72.5%), followed by support from professionals to address their own needs (59.2%), skills to care for stroke survivors, i.e., skills in caring for stroke survivors with their daily activities (57.9%), and skills in supporting stroke survivors to perform rehabilitation at home (53.1%). The lowest unmet need was related to support in transporting stroke survivors from place to place (45.3%). Additionally, this study did not identify an association between the reported unmet needs and gender, age, ethnicity, duration of caregiving, and site of participation. Conclusions This study reported a range of unmet needs perceived by stroke caregivers in Malaysia. Further research is warranted to understand the gaps in supporting local stroke caregivers to inform future post-stroke support and services in the country.

Relationship between Burden, Quality of Life and Difficulties of Informal Primary Caregivers in the Context of the COVID-19 Pandemic: Analysis of the Contributions of Public Policies

The study aimed to characterize and understand the difficulties experienced by informal caregivers from a bio-psychosocial and environmental perspective, taking into account the socio-demographic and health characteristics of the informal caregiver and the person cared for, quality of life, perceived burden, social support, and the impact of the COVID-19 pandemic on the informal caregiver and the person cared for. The participants were 371 informal primary caregivers, 80.9% female, aged between 25 and 85 years, mean 53.17 (SD = 11.45) years. Only 16.4% of the informal caregivers benefited from monitoring and training for informal caregiver skills; 34.8% received information on the rights of the person being cared for; 7.8% received advice or guidance on the rights and duties of the informal caregiver; 11.9% of the caregivers benefited from psychological support; and 5.7% participated in self-help groups. A convenience sample was used, and data were collected via an online questionnaire. The main findings show that the major difficulties experienced by caregivers are related to social constraints, the demands of caring, and the reactions of the person cared for. The results reveal that the burden of the main informal caregivers is explained by the level of education, quality of life, level of dependence of the person cared for, level of difficulties, and social support. The COVID-19 pandemic impacted caregiving by increasing the perceived difficulty of accessing support services, such as consultations, services, and support; causing distress feelings in the caregiver, such as, anxiety and worry; increasing the needs and symptoms of the person cared for; and increasing the degree of isolation, for both, the informal caregiver and the person cared for.

The Malay version of the caregiver assessment of function and upset instrument (Malay-CAFU): a translation and validation study among informal stroke caregivers

BACKGROUND

Post-stroke complications affect the informal caregivers equally as the stroke survivors, especially those who have a moderate to worst prognosis in functional capacity recovery. Caregiver Assessment of Function and Upset (CAFU) is one of the common tools used in both research and clinical practice to measure the patient's dependency level and the stroke caregivers' upset level.

OBJECTIVE

This study aimed to translate and validate the CAFU instrument into the Malay language and test the validity and reliability of the CAFU among informal stroke caregivers in Malaysia.

METHODS

A standard forward-backward translation method was employed to translate CAFU. Subsequently, 10 expert panels were included in the validation process, and thereafter reliability testing was conducted among 51 stroke caregivers. The validation of the instrument was determined by computing the content validity indices (CVIs), and we used the Cronbach's alpha method to explore the internal consistency of the overall score and subscales scores of the Malay-CAFU. Finally, the explanatory factor analysis used principal component extraction and a varimax rotation to examine construct validity.

RESULTS

All items of the Malay-CAFU had satisfactory item-level CVI (I-CVI), with values greater than 0.80, and the scale-level CVI (S-CVI) was 0.95. These results indicate that the Malay-CAFU had good relevancy. The internal consistency for the reliability test showed a Cronbach's alpha value of 0.95 for the overall score. The eigenvalues and scree plot supported a two-factor structural model of the instrument. From the explanatory factor analysis, the factor loadings ranged from 0.82 to 0.90 and 0.56 to 0.83, respectively.

CONCLUSION

The Malay-CAFU questionnaire is a valid and reliable instrument to assess the dependence level of stroke survivors and the upset level of informal stroke caregivers in Malaysia.

Factors associated with the well-being of family caregivers of people with dementia

BACKGROUND

Improving the health and well-being of family caregivers of people with dementia has become an increasingly important public health and policy issue in China. The aims of this study were to clarify the factors associated with the well-being of family caregivers of people with dementia in China.

METHODS

Data were collected from a sample of 132 family caregivers who volunteered to study and live together with people with dementia who had been treated as outpatients in three hospitals in China. The survey included questions on the family caregivers' characteristics, satisfaction with family support, positive aspects of caregiving, preparedness of caregiving, and characteristics of people with dementia. Multiple linear regression analysis was carried out to identify factors associated with the well-being of family caregivers.

RESULTS

The mean age of the family caregivers (68.2% women) was 46.8 ± 14.9 years. The results of multiple linear regression analysis indicated that positive aspects of caregiving (β = 0.352, P < 0.001), satisfaction with family support (β = 0.219, P < 0.01), activities of daily living of people with dementia (β = 0.265, P < 0.05), and household size (β = -0.184, P < 0.05) were related to the well-being of family caregivers.

CONCLUSIONS

The findings from this study indicated that positive aspects of caregiving, satisfaction with family support, activities of daily living of people with dementia, and household size were significant factors related to the well-being of family caregivers. These findings could be expected to aid healthcare providers in identifying the optimal solution to enhance the well-being of family caregivers in China.

The effect of informal caregiving on physical health among non-migrants and Ethnic German Immigrants in Germany: a cohort analysis based on the GSOEP 2000-2018

BACKGROUND

The number of people in need of care in Germany has been rising since decades, which is related to an increasing need and relevance of informal caregiving. Likewise, the number of people with a migration background has been increasing. This study aims to analyse the impact of informal caregiving on physical health in comparative perspective for Ethnic German Immigrants (EGI) - the largest and oldest immigrant group in Germany - and non-migrant Germans (NMG).

METHODS

The sample was drawn from the years 2000-2018 of the German Socio-Economic Panel (n = 26,354). NMG (n = 24,634) and EGI (n = 1,720) were categorized into non-caregivers (n = 24,379) and caregivers (n = 1,975), where the latter were distinguished by 1) their caregiving status and history (current, former, and never caregiver) and 2) the number of years in the caregiver role. Generalized Estimating Equations were applied to examine main effects and the interaction effects of caregiving status and migration background for changes in physical health (n = 102,066 observations).

RESULTS

Adjusting for socioeconomic, household related, and individual characteristics, NMG and EGI had similar caregiving patterns and physical health. However, the interaction between migration background and caregiving revealed significantly higher declines in physical health for currently caregiving EGI. Sensitivity analyses indicated that particularly socioeconomic resources moderated this effect.

CONCLUSIONS

Findings suggest that caregiving is associated with declines in physical health, particularly in the long term and for EGI. This implies that care-related disadvantages accumulate over time and that the association of caregiving, health and associated determinants are culturally diverse and shaped by migration background. Both the health disadvantages of caregivers and EGI might be mitigated by a positive social and socioeconomic setting, which highlights the relevance of supporting structures and benefits for these subgroups.